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Above: Very Serious Policy Analysis

For some reason, the New York Times has given op-ed space to Avik Roy, so he can prove that you can’t spell “reformicon” without “con:”

In 2010, when Democrats passed the Affordable Care Act, Republicans complained that they did so with no Republican support. Democrats responded by pointing out that the centerpiece of their plan — tax credits to buy private insurance — came from a Republican governor, Mitt Romney of Massachusetts.

Yes, some people did make the very dumb argument that statutes passed by veto-proof supermajorities of Massachusetts Democrats were useful inidcators of healthcare policies that federal Republicans should like. This argument was, however, very dumb and also irrelevant to the merits of the BCRA.

But Roy needs to pretend that the BCRA is actually a bipartisan bill, so he will repeat the same fallacy twice!

The Senate bill’s plan to reform Medicaid by tying per-enrollee spending to medical inflation through 2025 and to consumer inflation thereafter was borrowed from a nearly identical 1995 proposal by President Bill Clinton. Indeed, the main difference between the Clinton proposal and the Republican one is that the Clinton proposal would have tied per-enrollee spending to growth in the gross domestic product. Historically, medical inflation has been higher than G.D.P. growth.

If you click the link, you’ll notice that Roy is leaving out some crucial context — Clinton’s terrible Medicaid proposal was made in the context of trying to preempt a far worse Republican one. But, anyway, yes, it was terrible! It was also more than 20 years ago. If you want to know what “Democratic ideas” about Medicaid are now, look at the comprehensive legislation passed by the Democrats the last time they had control of the government, and how they’re responding to the Republican proposals now.

Anyway, this idea that once any Democrat proposes anything it’s therefore permanently a “Democratic idea” whose inclusion makes any plan bipartisan is remarkably asinine. “Woodrow Wilson nominates James McReynolds as Attorney General, so really Jeff Sessions was a Democratic idea!”

The Senate bill replaces the A.C.A.’s Medicaid expansion with a robust system of tax credits for which everyone under the poverty line is eligible. Under Obamacare, you could enroll in private insurance exchanges only if your income exceeded the poverty line.

Well, yes, the ACA didn’t offer credits for insurance exchanges to people below the poverty line, because these people were supposed to be offered Medicaid. It’s regrettable that John Roberts ineptly re-wrote the Medicaid expansion, but any states that haven’t taken the money remain welcome to do it!

The idea that the replacement offered by BCRA is “robust,” meanwhile, is ludicrous. The insurance theoretically offered to the poor would involve such high deductibles as to be entirely useless — very few poor people would buy such insurance and even fewer people would keep it.  Which is a crucial reason why the massive Medicaid cuts in the Senate plan would lead to huge numbers of people losing their health insurance.

The tax credit system employed in the Senate Republican bill is stronger than the A.C.A.’s, because it adjusts the value of the credits not only to benefit those with low incomes but also to encourage younger people to enroll in coverage.

Except, again, that the insurance that would be offered on the exchanges under BCRA would be worse and the tax credits much less generous, so the idea that large numbers of young people are going to buy insurance is silly. Lower premiums won’t be an incentive to buy and keep insurance if the deductibles are so high as to make the insurance useless.

If the Republican plan increases participation by the young,

If I had a billion more dollars I’d be a billionaire. So what?

Roy’s answer to the CBO analysis that 22 million people would lose insurance under the BCRA in order to fund a massive upper-class tax cut is quite simply pathetic:

It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today. [100 eyeroll emojis — ed.]

The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods.

The flaw in the CBO’s analysis is that…it’s scoring the bill being proposed by Senate Republicans, as opposed to some hypothetical bill passed by a future Congress that would provide more generous subsidies for the poor rather than brutalizing the poor to pay for an upper-class tax cut. It’s embarrassing that Roy would type this shit and it’s embarrassing that the Times would publish it.

And now, the punchline:

Roy emails back:  “As a matter of policy, I don’t discuss with the press my conversations with policymakers.” So, if you’re curious whether he helped write the plan he has been touting in a number of op-eds and interviews, Roy isn’t saying, but “yes” seems like a fairly safe assumption.

I dunno, maybe the Times should make him answer this question before it publishes his feeble propaganda as if it was serious analysis?

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  • Dr. Ronnie James, DO

    6 months ago, Roy was so puboicly disillusioned when Trump’s success revealed his beloved GOP was rotten with racists. Truly, time, and the chance to wound millions, heals all wounds.

    • Murc

      Oh, Avik Roy is still upset about that. He hates the racism and the identity politics. It distracts from the class war, donchaknow.

      • Dr. Ronnie James, DO

        So he’s trying to get people who hate you bc of your DNA or what continent your ancestors lived on X,000 years ago to hate you for your annual income level. Hope that works out for him.

    • Derelict

      If we do not punish people for being poor, there would be no incentive for them to get rich! Making it so that you only get the healthcare you can afford should incentivize everyone to become at least a millionaire within the next 12 months.

    • rea

      Time wounds all heels, and Roy qualifies.

  • Derelict

    “We’ve lowered premiums so that the poor can almost afford health insurance!”

    “Sure, but the only policies the poor can afford have monstrously high deductibles and do not cover most of the diseases and conditions they’re likely to suffer from.”

    “Tosh, mere details! Besides, you have to look at all these other things that don’t exist and these other events that will never take place before you judge this plan. Also, too, Clinton.”

    Sadly, all of this is what passes for deep intellectual thought on the Right these days.

  • Short Avik Roy: I am open to thoughtful critiques of the Senate bill. That said, any suggestions that the bill would significantly increase disease, death and financial penury in order to fund an upper class tax cut are beyond the pale, impertinant and unworthy of polite, thoughtful policy discussions. Consequently, any polite, thoughtful discussion will invariably conclude that there are actually no thoughtful critiques to be made of the Senate legislation! QED.

    • LosGatosCA

      Even shorter – I was almost excommunicated from the GOP pundit gravy train and I had to do something to get back in their good graces.

      BTW, racists aren’t all that bad if they write me a check.

  • CP

    I’m very open to thoughtful bills for the reform of our health insurance process. “Let’s kill millions” is not it.

  • NonyNony

    If Roy wanted to have thoughtful critiques of this health care bill, he should have insisted that Republican put some thought into it.

    Even I am kind of shocked at how brazen it is. They used to be pretty good at dressing up their cashgrabs for the rich as something that would help everyone. They aren’t even trying.

    Suggests to me that McConnell suspects that 2018 will be a massive blowback year anyway and so they should just grab what they can get. I wonder if some major abortion legislation will get pushed through the Senate too just because McConnell thinks that the worst that will happen is being out of power for roughly 4 years from 2018 – 2022 and then the Republicans will have it all back again. I’ve never thought that they’d actually go through with a massive anti-abortion bill because the blowback would be so severe, but the lesson of the W years seems to be that Republicans will only be punished for at most 4 years for their malicious incompetence, so why not take what you can while you can?

    • so-in-so

      Sure, the people were “dressing up” bills were all RINOS. What left are people into the power that the GOP celebrates (and whines incessantly about when balked).

      They are the only legitimate leaders, so they grab power when it is available. When you are a political, they let you do anything. 2016 proved that finally (while 2010-1016 was the testing ground).

  • Cesspool

    The death panels article is truly remarkable, I had to go back and read it.

    His argument is literally, “Doctors should have voluntary end-of-life discussions with their patients, as originally proposed in the ACA, but they should NOT be reimbursed by the government for these discussions, because freedom.”

    • Dr. Ronnie James, DO

      Taxpayers should continue pay for end-of-life care costing hundred of thou which neither doctor nor patient want bc reasons.

    • BiloSagdiyev

      When I was a little boy, Republicans claimed to be the keen-eyed realists, saying that not everything was doable and everything had a cost.

      But now 15 or 30 minutes of talking to a doctor is as free as the wind. Duly noted.

      • Cesspool

        Verbatim: “Why do we need a government program to pay doctors to have thoughtful conversations about their patients’ eschatological desires — something they should be doing already, and that doesn’t cost a dime?”


      • Dr. Ronnie James, DO

        At least one successful family practice doc I’ve worked with would do “end of life counseling” by asking a patient if they had an advanced directive (usually in a waiting room questionnaire, explaining what they were & answering any questions, and then handing them a list of lawyers & other professionals who could execute it for them. 3-5 minutes tops!

  • NewishLawyer

    To be fair, Vox and I think one other ostensibly left-leaning outlet gave Roy some space as well.

    During the Obama admin, Drum and some other bloggers wondered if the Democratic Party was always at a disadvantage because there was a “hack gap.” You see this in Democratic infighting where someone like me wants universal health insurance but will roll eyes at people who get angry when proposing the pie-in-the-sky California plan which slowly triples the California budget end up blocked.

    The other thing that hurts us here is the chummy world of pundit and journalists. I imagine that someone at Vox or the Times, maybe multiple people are appalled by the GOP plan but they are personal friends with Roy and willing to give him space cause that’s what friends are for.

    • Paul Campos

      I think it’s more that Roy is the semi-official administrative spokesperson for a major piece of legislation, and such people by custom get to pitch the legislation in the NYT.

      It’s a two-party system you know. (I don’t know how to do the sarcasm font).

      • NonyNony

        Surround it with <code> tags.

        Like this

        (I wonder if the sarcasm font will go away when the swithc to Disqus occurs…)

        • HowardBannister

          Just checked on my Disqus account; it works. Looks slightly different.

      • Colin Day

        (I don’t know how to do the sarcasm font).

        Enclose it in <code> and </code> tags.

      • BethRich52

        There’s a sarcasm font?

        • As the others have said, the monospaced font is used to denote sarcasm on this blog as one of our many Internet Traditions. It can be deployed by surrounding the sarcastic text with <code> and </code>.

          • Procopius

            Ah. I was not aware of that internet tradition. Thank you.

    • malraux

      At least at vox, Ezra has the personality fault of projecting his own good faith intentions onto everyone. It makes the situations where yglesias gets to point out legitimate bad faith actions (the Ryan budget or this health care legislation) rather contentious.

    • Phil Perspective

      You see this in Democratic infighting where someone like me wants universal health insurance but will roll eyes at people who get angry when proposing the pie-in-the-sky California plan which slowly triples the California budget end up blocked.

      People admitted the CA plan wasn’t even a finished bill. The problem is that the CA Assembly(or House) Speaker pulled the bill completely. Meaning there is no chance for alterations or amendments. Isn’t California like the 6th or 8th largest economy in the world? Why not let the process play out? Unless Rendon was purposefully trying to strangle single-payer in the crib?

      • L2P

        Politically, they pulled it because they thought it might cost them their super majority. They didn’t want to have tossup candidates have to either support it (and huge tax increases) or go against it (and so being against health coverage).

        The cost was just too high. It’s more important to keep that super majority super safe than argue over a health plan that was never going to pass.

        • Tyto

          This is correct. The optics of simply plowing forward, given the economic analysis and in the current federal funding environment, were terrible.

    • Aaron Morrow

      Vox wrote up a couple of different versions of Roy’s “the House plan was awful” bait, but that’s no reason to feel obligated to transcribe his “but the Senate plan is spectacular” switch.

    • Lurking Canadian

      You see this in Democratic infighting where someone like me wants universal health insurance but will roll eyes at people who get angry when proposing the pie-in-the-sky California plan which slowly triples the California budget end up blocked.

      One sad (for me) lesson of the 2016 electoral campaign was that there are a lot of Dem-leaning liberal Americans who think raising taxes to pay for expanded social programs is self-evidently a crazy idea.

      • Raising taxes to pay for social programs isn’t crazy, but passing a state plan that relies on somehow convincing the federal government to hand over Medicare funds as a lump sum of cash every year is very much so.

    • The Lorax

      Ezra speaks well of Roy. I can guarantee if it were up to Yglesias alone that Roy would not have a platform.

  • JMV Pyro

    Fuck me do I have contempt for this guy. Sure, there are plenty of people worse then him on the right, but the way he’s trying to pretty up this monstrosity of a bill is just disgusting.


    “The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods.”

    Fuck you. If you wanted them to include that in their analysis, they(and you) should have included that assistance in the damned bill.

    • Dr. Ronnie James, DO

      aka “it’s not a bug…”

    • BiloSagdiyev

      regardless of what senators do to direct more financial assistance to the poor and the vulnerable.

      Curse you, reality-based CBO! How dare you assume we’re not going to do shit for the poor!

      • Procopius

        “Prongs.” You have to remember the prongs. Three prongs. It isn’t until you get pronged the third time that you will see what their full plan is. See John Oliver’s dissection of Sean Spicer explaining why the House plan looks bad. It’s only the first prong. Prong, prong, prong. There’s still a second prong (the tax cut?), and after that a third prong we aren’t talking about. It’ll be a yuge prong.

  • JKTH

    Historically, medical inflation has been higher than G.D.P. growth.

    Among all the other things in there, this hasn’t been the case in recent years, it isn’t the case going forward according to CBO, and it isn’t very relevant since Medicaid would be eventually tied to plain old inflation.

  • Phil Perspective

    For some reason, the New York Times has given op-ed space to Avik Roy, …

    The NYT always has room for right-wing grifters. They published one-time member of #TheResistance Louise Mensch just a couple of weeks ago, despite many of us always knowing she was a crank and a grifter. People should get educated and stop acting so shocked.

    • Marlowe

      No shit. About a week ago they ran a piece arguing that Democrats (like Jewish Jon Ossoff) need to pander to white evangelicals in order to win. The writer’s principal credential appeared to be that he was a history professor at the very prestigious University of West Georgia–just like Newtie! (OK, I admit to being something of an academic snob; my degrees are from Colgate and Cornell Law. A character flaw, but there it is.)

  • Denverite

    Someone needs to make sure to meticulously monitor everything that Roy says. If he’s going to become the Jonathan Gruber of Trumpcare, the GOP needs to own him just like they tried to make the Dems own MIT Professor, Chairman of the Fed, Junior Senator from New Hampshire, Secretary of the Interior, and Starting 3B for the Pawtucket Red Sox Jonathan Gruber.

    • Davis X. Machina

      Starting 3B for the Pawtucket Red Sox Jonathan Gruber.

      Now you’re just jerking my chain.

      If this were true he’d already be up in Boston.

  • IM

    Chait is on a roll.

    There are positive developments. In years past Chait would have been one of the first to apologize for Roy.

    • NonyNony

      I think Trump finally maybe got something through Chait’s thick skull. Perhaps he finally realizes that the people he’s been buddy-buddy collegial who are all-in on Trump are not, in fact, good people. And that maybe excusing their bad behavior isn’t actually helping anything.

      • Scott Lemieux

        Chait has his blind spots, but he’s always understood that conservative intellectuals are basically charlatans, and he’s been particularly merciless about the “reformicon” bullshit.

        • IM

          Not always. Not in his TNR days.

  • epidemiologist

    Christ the acronym for this bill is awful. Is everyone involved so ignorant that they didn’t notice it looks like BRCA? They are basically acknowledging this plan will give you cancer.

  • BethRich52

    I had my first full time job at 18. For the first 6 months the company required an employee contribution for health insurance; after 6 months the company paid the entire premium. I was healthy, never had had serious health problems, so I decided to wait the 6 months before signing up. Guess what? I had to be hospitalized within a month or two of starting that job & had to pay the whole thing out of pocket. Many young people won’t buy health insurance because they think they’re bullet proof & opt for the money. I did that & paid a higher price.

    • rm

      The entire Republican line on “young, healthy” people not being “forced to buy something they don’t want” is disproven by the existence of car crashes.

      Of course, car crashes are an incredibly rare occurrence, that almost never happen unexpectedly.

      • howard

        just to get an empirical handle, i took a quick look at the number of car-crash injuries in the u.s. since i was only willing to devote 60 seconds, i’ll take wikipedia’s numbers from 2010:

        In 2010, there were an estimated 5,419,000 crashes (30,296 fatal crashes), killing 32,999 and injuring 2,239,000 (https://en.wikipedia.org/wiki/List_of_motor_vehicle_deaths_in_U.S._by_year).

  • Happy Jack

    His “think tank”, FREOPP, is lacking in details about who funds them. That might provide background for his views.

  • Origami Isopod
  • Eli Rabett

    Avrik Roy is running for the vacent Dinest D’Souza position in the grifters hall of fame.

  • Quaker in a Basement

    “Millions will die is not it.”

    OK. Thousands will die.

    Happy now?

    • tsam

      “Well, I was kinda hoping for millions…”

  • I’m very open to thoughtful critiques of this Death Star from the left, but “millions of voices suddenly cried out in terror and were suddenly silenced” is not it.

    • CP

      There are “Alderaan Deserved It” articles out there, which I generally see retweeted by, of course, conservative acquaintances.

  • StevveL

    Exactly right, thank you for this. I actually asked the Times (and the WaPo!) to request that Roy answer Chait’s question, and then to take appropriate action under their policies. Unfortunately with no more Public Editor, it’s not clear if anyone will even see this as their responsibility.

    My letter to the Times yesterday:

    Much is wrong with Avik Roy’s description of the senate health care bill and preceding history – Bill Clinton’s Medicaid cap was proposed in the context of even more draconian demands from the Republican congress that shut down the government in 1995, for example, and the tax credits that Mr. Roy describes as “stronger” actually involve about $400 billion less than current law over ten years. Even taking license to fudge facts, however, Mr. Roy cannot quite bring himself to explicitly endorse the bill. Instead, he dedicates several paragraphs to praising an imaginary middle-ground bill, and concludes by assuring readers that the senate bill would not quite erase all the accomplishments of the ACA, leaving some net progress (the CBO disagrees, projecting a return to pre-ACA uninsured rates). It speaks poorly of the bill that even as devoted a cheerleader as Mr. Roy cannot make a straightforward case for it.

  • skeptonomist

    If everything, like Social Security benefits and wages, were tied to nominal GDP instead of prices (CPI or other measure) that would generally be a good thing, because real GDP usually increases! That is, nominal GDP increases faster than consumer prices! So the Senate plan is a major cut with respect to Hillary’s plan. Of course medical expenses have increased even faster than GDP, so if healthcare benefits were tied to GDP rather than medical expenses that would be a kind of cut unless the growth of medical costs were brought under control. The way to reduce those costs is have the government take over pricing, which is how other countries do it – letting the “free market” do it isn’t working.

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