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The Infuriating Bad Faith of Arguments That Health Insurance Doesn’t Improve Health Outcomes

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It’s like, how much more McArdle could this be?

Republicans want to kill you. Worse than that, they want to kill you so that they can give your money to rich people who don’t need it.

Why, yes. This is entirely accurate. Well, actually, “you” should be replaced with “poor people” — the typical McArdle reader isn’t very likely to have their access to healthcare being put at risk. To continue:

If you’ve been reading social media over the last week, that’s the main message you’d take away. It started when the Senate released its long-awaited health-care bill, the culmination of nearly a decade’s promises to repeal and replace Obamacare. This bill was not so much a repeal as an adjustment, and not so much an adjustment as a tweak. But it did propose to eliminate most of the taxes used to fund Obamacare, including the reviled individual mandate. And alter the funding structure of both Medicaid and the premium subsidies to make them somewhat less generous. So obviously: Republicans want to kill you. Their rich donors need your bodies to use as mulch on their diamond plantations.

McArdle think she’s engaging in hyperbole when, in fact, she’s describing the BCRA. It takes more than a trillion dollars in health care funding, mostly for the poor, and gives most of it back to the very rich in a tax cut. The consequences of the cuts will be preventable death, suffering, and financial ruin.

And the thing is, in the rest of a fairly long column, she doesn’t really rebut this, just repeats some Roy-like nonsense about how under the BCRA insurance is a “sweet deal” for the poor which completely ignores the deductibles that would make insurance completely worthless. Here’s the thing: you can’t massively reduce subsidies without massively reducing the number of poor people without insurance, because (although McArdle doesn’t seem to understand this) poor people don’t have any money, let alone 6 grand a year to spend on co-pays. But, then, really a more than trillion dollar cut is just a “tweak.”

One approach, which McArdle has used in the past, is to claim that that the BCRA’s massive reductions in spending and hence in the number of people with insurance are no big deal because insurance doesn’t really have any value. Friend of the blog Avik Roy:

The Senate bill includes and refines the best part of the House bill: its reforms of Medicaid, the dysfunctional government-run health care program for the poor whose enrollees have no better health outcomes than the uninsured.

Ross Douthat — who at least opposes BCRA — makes the claim vaguer and applicable to all insurance:

The best conservative health policy analysis proceeds from the controversial but, I think, correct perspective that much health spending is wasted and that people do not value or benefit from insurance as much as liberal technocrats presume.

The stronger, more specific version of the claim leans heavily on cherry-picking one study about Medicaid in Oregon, which 1)by its nature could not have demonstrated that Medicaid was no better than being uninsured and 2)did no such thing in any case.

Anyway, there is more than one study out there. Does the evidence support the incredibly implausible idea that being insured does little or nothing to improve health outcomes? Of course not. The evidence is overwhelming that people on Medicaid benefit substantially from having insurance. The best evidence indicates that upwards of 30,000 people a year will die preventible deaths if BCRA becomes law. So, while it might sound like Swiftian hyperbole, “Senate Republicans will make poor people suffer and in some cases die to pay for an upper-class tax cut” is, in fact, entirely accurate.

What’s particularly infuriating is that this ridiculous speculation is being engaged in by people who will never themselves be without good insurance. None of these people are going forego anything but ER care the rest of their lives. Conveniently, if Republicans succeed in passing this unspeakably appalling bill, “being uninsured — is it really bad for your health?” is an experiment that will be carried out on other, less privileged people. And if it turns out that lacking insurance leads to pain and suffering and death, as the evidence actually indicates, well, they owe you a coke! (Note: offer of a coke will not be honored, moocher.)

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  • StellaB

    I’ve actually seen people die from lack of insurance, but who should I believe, the Republicans or my lying eyes?

    • CP

      Yep, same here. A co-worker who moved back home from NYC to Florida after losing his job, had no health insurance in Florida despite the fact that, as he was prone to seizures, he really needed it, and who passed away a couple months after I moved out of Florida (in large part to avoid the shit-show of that non-ACA-expansion state). It was a sobering way for the world to emphasize to me that yes, the abominable safety net kills people all the time, mostly unnoticed and treated as just part of the background.

    • tsam

      Me too. An aunt (well, people we called aunt/uncle/cousins).

      Couldn’t afford the heart treatment. Killed her at about 60. Her daughter had to bring her dad down to Texas and practically bankrupt herself to get him into a marginally humane home for his Alzheimer’s as well.

      • Derelict

        In this, the greatest country the world has ever known, the shining city on the hill, the acme of the wealth-generating power of freedom and capitalism, we as a society have decided that the only reasonable response to old age is to force the elderly AND their families into penury.

        Because nothing will mage America great again like pushing the grandparents out to sea on a ice flow.

        • Pat

          Absolutely, Derelict. Republicans in the richest country in the world are planning to throw old people out of nursing homes to pay for a tax cut for the rich.

          I wish it was hyperbole.

        • tsam

          She’s also a nurse and a rabid right winger (the Texan type, loud, brash and wildly uninformed)–I still don’t wish this kind of thing on her, but the cognitive dissonance of being directly damaged by this shitty fucking system might soften her stance, but to date, nothing. I fucking give up. People are so factional and seem to believe any fucking thing they’re told, regardless of any factor outside of their little bubble of propaganda. It even has me often questioning my own views and beliefs to make sure I’m not falling victim to the same thing. Shit’s gotten weird if I’m feeling gaslighted by simple facts because there is so much information out there, billing itself as the truth, that the truth seems like a quaint, distant concept that can never be had–like a fairy tale marriage.

          • so-in-so

            Oh, no doubt it will be “if that evil Obama hadn’t messed with health care we’d have been fine…”. Pretty obviously wrong if you either read anything not Fox-worthy or remember the status-quo-ante, but both those can be not the case (or ignored by the tribally motivated).

            • StellaB

              The incredible idea that health insurance premiums never rose before the ACA. In 2007 my employer’s premiums rose 27% — in one, single year — years before the ACA had even been considered.

    • sam

      “dying” also isn’t the only negative outcome of our old system.

      Even when people had what was considered “good” insurance under the old system, there were massive issues that the ACA tried to solve (like the lifetime limits, pre-existing conditions ban, etc.).

      On the latter, I had a friend/former colleague who spent almost TWENTY YEARS in a job she hated before being able to go back to school in the mid 1990s specifically because New York State passed it’s own version of the pre-existing condition ban. She had Crohn’s disease, and was basically trapped in her job because if she left, she’d be uninsurable. When we met, we were at the same level, law-career-wise, even though she was 20 years older than me, and she was a GREAT lawyer. That she spent 20 years being miserable doing something she hated absolutely had an impact on her.

      She passed away a few months ago (after a sudden stroke, six months after she had been recovering quite amazingly from an intestinal transplant operation), and I think about her battle for her health, AND INSURANCE, and to live a life on her terms, constantly during this current clusterf*ck.

      And this was someone who could afford good/expensive insurance. But if it weren’t for the type of protections afforded by the ACA (passed earlier by NY), no one would have sold it to her.

      • Denverite

        On the latter, I had a friend/former colleague who spent almost TWENTY YEARS in a job she hated before being able to go back to school in the mid 1990s specifically because New York State passed it’s own version of the pre-existing condition ban. She had Crohn’s disease, and was basically trapped in her job because if she left, she’d be uninsurable. When we met, we were at the same level, law-career-wise, even though she was 20 years older than me, and she was a GREAT lawyer. That she spent 20 years being miserable doing something she hated absolutely had an impact on her.

        Just a nit, but it was probably HIPAA that allowed her to leave her prior job. It was passed in 1996 and required group health plans to accept preexisting conditions if the insured had had continuous coverage for more than 12 months with no gap longer than 63 days.

        • Daglock

          That’s one of the reasons the GOP hates Obamacare. It allows workers too much mobility, because they aren’t chained to shitty jobs just to hang onto health insurance.

        • sam

          No – It was the law New York passed in 1993. It was called the New York guaranteed issue health insurance law.

          My friend started law school in 1995, so it literally could not have been HIPAA.

          • Denverite

            Ah, it was the “mid 90s” bit that threw me off. Anyway, HIPAA accomplished the same result in the continuous coverage group health context in 1996.

            • D. C. Sessions

              Perhaps overriding all such State laws will be one of the sweeteners that the Republican leadership offers to get holdouts on board.

              • sam

                This is one of the things I worry about the most. Right now, as a New Yorker, I console myself (and my friends) with the idea that even if the feds roll back some of this stuff, NY’s laws are still on the books, so we’ll still have some baseline protections.

                But if they do their (euphemistically named) “getting rid of the barriers between states” bullshit, that could all go away too.

  • D.N. Nation

    If McBargle is sadly, inevitably proved entirely wrong, watch for her to bring back the ol’ classic:

    “This is all technically true, and collectively nonsense.”

    • Scott Lemieux

      It’s not a statistic, it’s a hypothetical.

  • N__B

    If insurance has so little effect on outcome, why do all those super duper intelligent conservatives waste their money buying it?

    • wjts

      It’s a Veblen good – they only buy it because the Poors can’t.

      • mojrim

        Oooo… Nice McArdling there.

    • Lizzy L

      Indeed. I think Avik Roy and Megan McCurdle and all those GOP Senators should simply give up their health insurance, as an example to the rest of us poor deluded fools who insist on signing up for it every year. Presumably they would then pay for their health care (including surgeries and chemotherapy and prescription drugs of all sorts) themselves, out of pocket. Or perhaps they would go to the ER for their care, as they assure us all American citizens can always do? Yeah, right. Anatole France, call your office.

      (“The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”)

      • Pat

        Ooh! Ooh! They could raise chickens and trade them for medical care, just like in the old days!

        • Bill Murray

          Where have you gone Sharron Angle, a party turns it’s lonely eyes to you, woo, woo, woo

    • tsam

      I assume it’s still cheaper than monthly trips to Tijuana for bonerpill refills.

      • Denverite

        Tijuana, you say?

        • tsam

          Yes sir. Wanna carpool? I can swing through Denver.

          • Denverite

            This is starting to sound like the premise for a very promising road trip comedy. Which one of us gets to mistake the pills for tic-tacs, resulting in all sorts of priapism hilarity?

            • rea

              I actually had a client go to jail a few years ago for selling tic-tacs to an undercover agent.

              • wjts

                Did they send him up the river to Sen Sen?

                • Davis X. Machina

                  +1923

              • Schadenboner

                When someone, especially an undercover cop, asks for Wintermint the solution is not “An Orange Mint and some White-Out”.

                No one to blame but himself, sadly.

                • rea

                  Pretty much what happened, except that the undercover agent asked for Hydrocodone rather than wintermints.

            • N__B

              If your road trip is erect for more than four hours call your doctor stop watching Michael Cimino movies.

            • tsam

              Snakes in a Car–

              I’m calling to get this trademarked RIGHT NOW

            • Bill Murray

              who will be Hot Lips Barton, and who will be Scat Sweeney?

  • NonyNony

    If McArdle doesn’t believe that health insurance doesn’t improve health outcomes, why doesn’t she go without it for a while? She can blog the whole experiment in living without insurance – I can’t wait until she finds out how much her primary care physician actually charges.

    • Derelict

      This, of course, is the only possible response: If you really believe that not having insurance makes no difference, then drop your coverage and we’ll talk again in 5 years.

      The problem with doing this to McMegan is that she’s young enough to be able to go 5 or 10 or even 15 years without seeing a doctor before something bad becomes too obvious to ignore.

      As for finding out how much her physician charges, many doctors will not accept you as a patient if you do not have some form of insurance. It doesn’t matter how much money you have, their billing is not set up to handle the self-insured. So, yeah: No insurance means no healthcare. Period.

      • NonyNony

        If Megan McArdle is actually young enough to be able to go 5-10 years without health insurance then perhaps she actually has a point, given that she’s 44 years old.

        I don’t think this is actually the case. That’s my age, and I would not be comfortable going for 5-10 years without health insurance at this point. The worrying about not having health insurance would probably do more to kill my health than anything else.

        • Derelict

          Most 44-year-old people could easily do 5 years without seeing a doctor provided they had no pre-existing conditions that need constant monitoring or treatment, and provided nothing extraordinary happens to them. Ten years might be a stretch, but it’s not inconceivable.

          But, then, there’s always something you just can’t foresee. One insect bite can give you all kinds of interesting maladies; one weak blood vessel is all it takes to land you in the ICU for a week.

          • D. C. Sessions

            Or for that matter, one drunk driver.

            Or some nut with a gun.

        • Jon_H11

          She’s 44 and still making arguments that sounded stupid coming from my freshman floor-mate? Sad!

          Seriously, I assumed she was like 25 just because I thought it was impossible for some one to make it that long and gain so little wisdom.

          • Steve LaBonne

            Her salary depends on her not understanding.

          • rm

            She is perpetually a college freshman, and not in a good way.

      • Rugosa

        IIRC, McArdle has some kind of chronic stomach trouble* – i.e., a pre-existing condition. So under the BCRA if the state she lives in drops mandatory coverage, she would be screwed. Of course she expects to never lose her ESI so she doesn’t think about that.

        *insert joke about how maybe she should stop eating her own cooking

        • rea

          She voted for the Leopards Eating People’s Faces Party . . .

        • Kathleen

          I thought that was her calculator.

        • brad

          Oh, she badly needs her coverage and would suffer without it. But she also lacks the capacity for empathy that non-conservative human consider an essential part of humanity. She will always have the coverage that comes from extremely wealthy parents, no amount of failure will ever dent her quality of life. She doesn’t have to care, and will stop inviting you to dinner parties if you try to trouble her with concepts like guilt or caring for others.

    • SatanicPanic

      They’ll say that it’s too late because health insurance has distorted the market too much.

      • NonyNony

        But that isn’t the argument they’re making here. They’re saying that right here, right now in the world we live in, health insurance doesn’t track with health outcomes.

        • SatanicPanic

          Sure, but we’re talking about people making bad faith arguments, right? Those goalposts will move.

          • NonyNony

            You’re right. Argument by Non-Sequitor is pretty much their MO these days.

            • tsam

              Yeah but Obummer and Bengazzy though.

              • SatanicPanic

                Don’t forget Fast and Furious.

                • farin

                  We could afford single-payer if not for Solyndra!

    • L2P

      A better question for her would be, “If insurance is useless, why does the free market still provide it?”

      If I truly believed in the free market, a “useless” commodity shouldn’t still be in existence after 50 years. The whole point of the free market is that it should reward “useful” things and punish “useless” things. If something doesn’t have much value to users (like, say, horse-drawn carriages), the market should stop providing it. But after 50 years their remains a huge market in both employer and individual health insurance (and so exists regardless of any tax advantages).

      So why is that, free market advocate? Does the free market not adequately allocate resources to the best use? Or is the insurance market a huge market failure? Either way, government intervention is required.

      • NonyNony

        They would respond with “government regulation”, of course.

        If we just eliminated all of those pesky regulations on everything, the insurance market would obviously collapse overnight.

        • D. C. Sessions

          In other words: get rid of the FDA and all medical licensure.

          I eagerly await Kansas doing that as their next experiment in Libertarianism.

          • rm

            Hey, Rand Paul invented his own licensing board and certified himself as an eye surgeon. Hand-made, small-batch, bespoke professional licensing is the way of Freedom.

      • Robespierre

        People buy gold, don’t they? It’s not like that’s a useful commodity, except insofar as bigger fools buy it.

        • KithKanan

          Gold is actually an incredibly useful commodity because of it’s electrical and chemical properties. Where those aren’t absolutely critical, we make due with substitutes because all of the demand from hoarders and people who like shiny things have jacked up the price higher than it otherwise would be, but in most cases gold would be better.

          • Derelict

            To be fair, there really isn’t all that much gold floating around above ground:

            How much above-ground gold (gold that has been mined) is there in all the world? The best estimate at the end of 2011 is that around 165,000 metric tons (or tonnes) have been mined in all of human history. That’s about 181,881 ordinary tons or 363,762,732 pounds, or 5,820,203,717 ordinary ounces.

            via NumberSleuth

          • Bill Murray

            light reflectivity, too — Astronaut helmet face shields had a thin layer of gold coating them to protect the astronaut from solar radiation

            https://spinoff.nasa.gov/spinoff1997/hm2.html

        • rm

          You just don't understand its INTRINSIC VALUE in contrast to FIAT MONEY.

  • saraeanderson

    I can’t imagine that I’m the only person for whom a few overpriced pills per day are the difference between being a taxpaying worker and charity case. But hey, any baby in that much bathwater is too expensive to save.

    • bizarroMike

      Well, if the “baby” is unborn and you are doing the bath water tossing, then the Republicans would like a word with you. Otherwise tough luck and also you should have made better decisions and also please die someplace out of the way.

    • Derelict

      There are lots (tens or hundreds of thousands) of people like me who are taking thyroid replacement hormones. These are relatively inexpensive (about $3/pill), but they mean the difference between living a completely normal life and suffering an extremely slow and agonizing death.

      But I guess I should have chosen better parents instead of picking the ones who carried this particular gene.

      • Denverite

        Ditto blood pressure medicine.

      • L2P

        You’re forgetting that if we let the free market work it’s magic, those pills would be close to free. McArdle’s pretty clear on that.

        • Derelict

          I’m eating peanut M&Ms right ow. I’m sure that the FreeMarket Fairy would guarantee that my Acme Thyroid Pills would be just as efficacious as those M&Ms for my condition.

          • L2P

            You’d be lucky if they only were as harmful as M&Ms. More likely they’d be made with a handy arsenic and sulfur blend.

      • Karen24

        I have a terrible family history of Type II diabetes. My mother is still alive and kicking at 79.5, and her mother lived to be 97 while mostly ignoring doctor’s instructions, but getting the diagnosis would immediately make me uninsurable.

      • StellaB

        $3 per pill for levothyroxine? More like $4 for 30 at Walmart. It’s probably cheaper to pay cash for them than to pay your copay for this particular medication, but the pharmacist usually forgets to point that out to you.

        • so-in-so

          Mine are literally free as long as order the 90 supply by mail, but I don’t suffer an agonizing death without them – tired and draggy, yes. So probably much lower dosage.

          • Derelict

            For me? No pills means slow failure of my organs over the course of years.

        • Derelict

          I was on Synthroid, which was $3/pill. Now on Levo, which runs $5 for however much I get with insurance paying. The only reason I know the cost of Synthroid is because I had to buy an extra 30-day supply once for an extended business trip and insurance would not cover it. $90 for 30 pills.

  • Princetonlawyer

    BLOCK QUOTE “Well, actually, “you” should be replaced with “poor people” — the typical McArdle reader isn’t very likely to have their access to healthcare being put at risk.”

    I guess I count as a McArdle reader–I read her once in a while back when she was at Slate or The Atlantic, can’t remember which, found her jejeune.

    I am a self-employed lawyer; my husband runs a small business. He is 56 and I am 54. We have three children, ranging in age from 22 to 14. Through the firm I am affiliated with, I pay $38K per year (pre-tax) for our family’s health insurance (small group, roughly 20 employees.) Our conscientious office administrator shops diligently for insurance each year, so we change carriers each year, chasing the best deal she can find (in New Jersey). Our coverage is ok–$3K/family is this year’s deductible, I think–decent choice of docs, 80% OON coverage, etc.

    I’d be fine with a much higher deductible and lower premiums for good catastrophic care, because, compared with most Americans, we’re upper income and can afford the out-of-pocket (especially if it could reduce that hellacious premium.) But I also understand that, for most Americans, that trade-off is something they just cannot afford, without subsidies, as the CBO explains. Hence, I’m a fan of Obamacare, for reasons of public policy.

    For personal reasons, I’m also a fan, because Obamacare gave us the option, if need be, to buy insurance on an exchange, or through very-small-group via my husband’s business (3 employees). This could be a lifesaver, especially if our income drops and we just can’t keep paying that $38K/year. We have the usual range of mild disease, nothing too major, nothing expensive to treat, but all of it would qualify as “preexisting condition” chasing us into a high-risk pool if we ever left my group coverage.

    People don’t understand, that, with a pre-existing condition, it’s not that you can’t get coverage for that specific condition, it’s that you can’t get ANY coverage. You’re high-risk. We’re high risk due to; my husband’s (well-controlled) acid reflux, my (mild) anxiety, one kid’s asthma, etc.

    Am I a McMegan reader? Basically, yes–or, at least, certainly of that ilk. Am I at risk of losing health coverage due to the Senate money-for-the-rich-grab-fuck-you-Jack? Absolutely.

    Oh, and the irony– some years we do top the $250K where the modest Obamacare tax starts biting. I say, PLEASE, I would pay FAR MORE in that tax, to ensure continued access to health insurance for me and my family and everyone else. But, oh gee, looks like the Kochs and their ilk need the tax break, so too bad.

    I should add that my husband and I are precisely the small-business “job creators” the Rs pretend to champion. What I always wonder is, why would any intelligent small-business employer vote R? That is, if your business is non-polluting, pays above minimum wage, provides benefits, etc.

    • rlc

      I got introduced to the miracle sauce obtained when combining a pre-existing condition with market healthcare in AZ. I had a melanoma chopped out. Full body exams for 10 years, and the dermatologist pronounced me clean/cured/whatever. 3 years later, I started my own business, and my homemaker wife spent six months trying to get a family policy. Nobody would offer us one, or explain why. After something like a dozen interactions with a provider here, they confessed it was the melanoma, from 13 years earlier. So even though the medical side pronounces me clean, we could not obtain coverage, for any price.

      We solved this by her going back to engineering work.

      Republicans don’t give a damn about small business, or competition. What they care about are entrenching and strengthening already existing corporate power. Cf the fossil fuel industry, internet corporations, etc. etc.

      • D. C. Sessions

        You forget that the Republican definition of “small business” is a pass-through corporation. One like Bechtel, for example.

        • Joe_JP

          One can call this the “Bechtel test.”

          • Princetonlawyer

            Ooh, goody. Ima steal that.

          • Breadbaker

            That’s where one rich person talks only to other rich people and determines public policy for people different from themselves, right? I think Earl Butz lost his job telling a joke like that.

    • erick

      You get it sadly, a lot of people in your income bracket don’t.

      I think the biggest con the Right Wing pulls is convincing the moderately rich (the top 5-20%) that they are on the same side as the mega rich.

      If you work for a living, no matter how well off you are what is good for the investor class is rarely good for you, or at least we’ll down in importance.

      • Princetonlawyer

        Absolutely correct. And, the fact that people like us–one year’s missed pay away from penury–vote R, makes me think that the US isn’t quite the intellectual-elite meritocracy some claim it to be!! In other words, the R-voting 5-20% are no Einsteins.

        Only if you have banked enough to retire on immediately should you suddenly have to, and get your kids educated and launched, AND self-pay for potentially decades of nursing care if you ever need it, AND self-pay for all necessary medical procedures until you qualify for Medicare (because, presumably, if you suddenly have to stop working, you will no longer receive employer-based health insurance, and almost certainly be uninsurable on the individual market), etc., etc., should you side with the rentier class.

        By the way, my husband and I both carry multi-million-dollar disability insurance policies, for just that reason. But, at today’s interest rates, even a nest egg that size isn’t enough to keep you from the poor house eventually, if you are unlucky enough to be both disabled and long-lived.

        One more kick-in-the-teeth to the small-businessman: if your little company goes under, you can’t COBRA your health insurance. COBRA only works if the employer itself stays solvent and insured.

      • Pete

        Precisely correct.

      • mpowell

        You missed the post just a few days ago about how the top quintile is actually the group screwing everyone else over. It’s not just right wingers who are working this angle.

        • Princetonlawyer

          Missed the post, but read the NYT article! What a load. The run-in-placers are the ones making sure the fall-behinders are falling? Don’t look at those people hogging ALL of the productivity while ratcheting the treadmill speed up and up!! :)

    • CP

      What I always wonder is, why would any intelligent small-business employer vote R?

      I’ll be the obligatory smartass and say that the answer is in the question.

      • Princetonlawyer

        Yep.

    • Ronan

      “I should add that my husband and I are precisely the small-business “job creators” the Rs pretend to champion. What I always wonder is, why would any intelligent small-business employer vote R?”

      I’ve never really understood this either.

  • Daglock

    All this, and a pony, too? The GOP whined about Obamacare death panels. It is now clear that they didn’t care about people dying from being denied health care, they just cared about the bureaucracy of the reg-yoo-lay-shun writers and enforcers. If your legislation consigns millions of Americans to early death due to lack of health care right out of the gate, you cut back on federal health care bureaucracy. Or,in the alternative, the GOP is just a bunch of heartless weenie dickheads.

    • so-in-so

      Yes, I thought it obvious from when the initial fight over the PPACA was going on that there couldn’t be too much bad with the law if all the GOP could use in fighting it were obvious lies.

      Sadly, “obvious” isn’t obvious to the public in general.

    • erick

      All they cared about was a good message to scare old people.

  • The way conservatives distort the Oregon experiment’s findings makes me see red. Aside from them just cherry-picking outcomes, Oregon’s version of Medicaid (the Oregon Health Plan) is fairly unusual, and the experiment only lasted two years. Also, Oregon is very white, which makes the blood pressure findings unrepresentative of the national population of Medicaid recipients.

  • Dilan Esper

    The studies show that health outcomes are improved by insurance and bankruptcies are reduced. But actually only the hacks are saying that a specific number of lives will be saved. The studies don’t show that (and the New England Journal piece isn’t a study, it’s just a hack op-ed deliberately written as part of the health care debate, comparable to amicus law review articles about pending SCOTUS cases).

    That doesn’t mean lives aren’t saved. But it does mean that the effects are probably more diffuse and the more honest arguments are the ones that say Republicans are ruining people’s health and finances, not that they are murderers.

    • NonyNony

      Your Concern Is Noted

      • Scott Lemieux

        Nice goalpost-moving between “we cannot know exactly how many people will die because of BCRA” and “we have no idea if anyone will die at all.” But I’m sure Dilan’s longstanding opposition to the ACA and Medicaid and support for neoconfederate Supreme Court opinions that undermine them has nothing to do with why he’s ignoring what the evidence shows.

        • Denverite

          You know, Lemieux, if you had posted this ten minutes earlier you could have saved me the five minutes looking for Woolhander and Himmelstein’s meta study.

    • Lost Left Coaster

      So you’re making a distinction between “ruining people’s health” and killing people?

      • jim, some guy in iowa

        Dilan just wants us to suffer, not die! what kind of monster do you think he *is*?

      • Pete

        Many of the sick manage to linger in misery for quite a long time, so …yes.

      • ColBatGuano

        Dilan believes our arguments must be 100% accurate while the Republicans can tell any lie. Balance!

    • epidemiologist

      Isn’t this not at all what you said yesterday? I seem to remember my appeal to authority sensors itching, and giving in. Deja vu…

      In any case “the studies” won’t agree on one magic number of people who would be killed by this plan because they are all observational research with all the error and potential for bias that implies, plus random error. You should be looking for agreement in the direction and magnitude of effect among studies whose specific aim is to measure that– that’s about all that’s reasonable.

      Also, non-hacks absolutely do try to estimate the number of people who would actually have an outcome, are you kidding? There is nothing more serious or small-c conservative about reporting a rate or some other measure of association instead of an estimated number of people affected (basically this is a population attributable risk, a real population health measure we should probably be reporting more). All such measures incorporate an estimated count, or could be used to get one. Also, reporting the estimated number of people affected can be a less misleading way of conveying a population health risk because it takes into account not only the effect of health hazard, but the prevalence of exposure.

      If estimating the actual number of people affected by a health policy feels like an overreach to you, there is something wrong– it’s done all the time and should be done more.

  • janitor_of_lunacy

    I had a coworker who died two weeks before his rescheduled surgery for afib. The surgery which was originally scheduled six months earlier, but kept getting moved out due to his insurance company.

    My wife nearly missed a half-year of salary because the insurance company wanted her to try hormonal therapy for fibroids rather than have a hysterectomy, despite that being the standard treatment for women who no longer wanted children. They finally relented just in time for her to have surgery before the semester started. She taught sitting down for the first two weeks.

    I’m on Humira, and I suspect that, had lifetime limits still been in effect, I would be paying out of pocket for about five years before I reached Medicare age.

  • jamesepowell

    Is it any more infuriating or bad faith than “trees cause more pollution than automobiles do”?

    This kind of stuff has been Republican Propaganda 101. And the key to understanding it and why it works is realizing that they don’t make this argument to persuade anyone. They are merely telling their supporters what to think and say.

    Their supporters are already inclined – by emotion, tribal identity, or just habit – to agree with whatever the Republicans do. The propaganda is a tool to help them stay that way, just in case they have any personal qualms (doubtful, but . . .) or family or friends who are pulling them away from supporting the Republicans on this issue.

    • CP

      This, exactly.

    • ASV

      When was the last time the GOP tried to engage in persuasive policymaking, rather than bad faith bullshitting? In much the way that many people are stuck in 1939 or 1968, for me it will always be 1993, which was like a veil being cast over the experience of my first campaign engagement in 1992. As I remember it, the narrative seemed to portray the Gingrich people as having ripped the mask off the Republican Party, revealing it as having been Ol’ Man Power-Grab the whole time. I turned 14 in 1993, so I don’t have a great contemporaneous sense of what was what in the 80s. Obviously Nixon is a pretty serious milemarker on this path, but the rank nihilism of the last 25 years seems markedly different from the hard ideological conservatism of the previous 25.

      • Pete

        “…but the rank nihilism of the last 25 years seems markedly different from the hard ideological conservatism of the previous 25.”

        I was just a child when Nixon was in office, but I agree that there was a significant shift — as you note — which appears to me to have begun in the mid- to late-1980s, bearing fruit in Gingrich becoming House Speaker.

        I think the right would say something similar about the hardening of ideology among Democrats, but that seems to me to have been more reactive and (thus) to have begun somewhat later.

        • farin

          And in any event, Democratic ideology hardened into an insistence on efficiently providing public goods. The difference between Nixon and Gingrich is that Nixon had a positive agenda for the office, but Gingrich wanted to (1) win and (2) break the government.

      • That’s a good question. I don’t have a good sense of the “before” period. NR paying undergraduates to pretend to be baby pundits in the cause of antiliberalism (that would be the era when Brooks, Frum, and Goldberg, as well as Gorsuch, were in college) might be part of it.

      • CP

        When was the last time the GOP tried to engage in persuasive policymaking, rather than bad faith bullshitting?

        1964. Barry Goldwater, an asshole, but a sincere one, ran a campaign in which he explained to the American people that he really and honestly thought all the reforms of the Progressive and New Deal eras that had created their modern middle class society should be abolished.*

        He lost the popular vote 38-61. The Republicans got the message: ever since then, they’ve run their campaigns with an emphasis on incoherent cultural resentments, and only then when they’re in office do they try to privatize Social Security or abolish the ACA.

        [* And also that maybe we should use nukes in Vietnam]

        • so-in-so

          It took all the time since then to cultivate a GOP electorate that would shout ‘hell YEAH!” when they somewhat honestly propose ending all the reforms of the New Deal and most of the Progressive Era. It helps that many people in their bloc don’t think they benefit from those things, of that the GOP only means to take them away from “those people”.

          • CP

            Even then – it’s noteworthy that this is only happening now, and that during the actual election, Trump scrupulously avoided running on this. And specifically promised several times that no one would lose their health insurance, and that you can’t just have people dying in the street, and argued (as FDR warned that right-wing fanatics would) that he could do a better job of covering people and basically out-ACA the ACA.

    • . . . or accidentally heard a “liberal” news report on the radio.

  • D. C. Sessions

    Here’s the thing: you can’t massively reduce subsidies without massively reducing the number of poor people without insurance

    My, that would be a good deal! Alas, today seems to be an epic day for lots of writers to reverse their obvious intentions by typos. And for me to be a prick for pointing them out.

    • Steve LaBonne

      Republicans just want to split the difference by massively reducing the number of poor people. And not by giving them money.

      • Lost Left Coaster

        Once again we have to remind everyone out there that Swift’s A Modest Proposal was satire. Satire, people! Not a serious policy proposal!

        • D. C. Sessions

          Swift intended it as satire for the British, but by invoking American Exceptionalism the USA can actually make that dream a reality.

  • Good news, courtesy of David Anderson:
    https://www.balloon-juice.com/2017/06/27/keep-on-calling-4/

    I also saw in my Twitter feed a few hours ago that Turtle told Trump he might have to negotiate with Schumer if the bill fails.

    • Steve LaBonne

      Since the Republicans don’t actually give a shit about health care but just want to slash taxes on the rich, that will be a pretty short negotiation.

      • Jon_H11

        Yeah, I don’t see how a “negotiation” takes place here. Schumer isn’t going to give in on any significant repeal of the taxes— and that is the entire purpose of the bill. Let alone the fact that the “Freedom” caucus would mutiny in the house if it has even a hint of Dem input to it.

        • so-in-so

          I suspect the negotiation is really with the other GOP Senators, but Schumer is the cover so if fails, its the Dem’s fault.

          • smartalek

            Exactly.
            (For Trump and his Chumps, of course, it already IS all the Dems’ fault. This is for everyone else.)

  • Karen24

    It’s still not a win, but the R’s pulled this nightmare bill from consideration this week. They will get back to it after the recess.

    • Steve LaBonne

      Those of us encumbered with Republican Senators need to keep the pressure on.

      • StellaB

        Those of us who know people encumbered with Republican senators need to politely remind our friends and relatives to keep the pressure on.

        • randy khan

          Those of us not encumbered with Republican Senators need to keep the pressure on, too – there’s no reason not to call them after hours, or post on their Facebook pages (believe me, they don’t have time to track down where Facebook commenters are from) if you feel ethical scruples about not telling the truth when they ask where you’re from.

          Also, call your Democratic Senators to cheer them on. It’s not as critical, but they need to know that their stiff backbones are appreciated.

    • Lost Left Coaster

      Not a win. But it sure as hell helps to undo McConnell’s secrecy — now this ugly bill will be out in the daylight much, much longer before a vote is taken.

      • Karen24

        This is important. Publicize the contents wherever you can!

        • HowardBannister

          The troll talking point seems to be, “yes, what a nightmare it was pre-ACA! *eyeroll*” I’ve seen that nearly word-for-word everywhere.

          It’s a lie, of course, on two levels. One, things have improved greatly since pre-ACA, and two, the big cuts to Medicaid meaning we go even further back.

          That’s something needs to be countered, and loudly, every time they say it.

      • John F

        Yes, the magnitude of the cuts to medicaid are what finally seem to have gotten the attention of some folks who weren’t paying attention before-

        Plus the Prime Time Fox lineup’s resolute refusal to mention, let alone discuss this healthcare bill is fascinating, they’re shameless as all hell, but even they can’t figure out how to sell this turd, they are almost frantic to discuss ANYTHING else.

        Let’s not forget, Trump got 46% of the vote, House GOPers got 49%, some number (not huge but not zero) of those voters are right now personally worried about losing coverage.

        Gotta keep talking about it, whether it passes, fails or gets tabled, gotta keep talking about what the bastards did or tried to do.

    • Daglock

      Apparently, the GOP needs more time to let free-market capitalism, in the form of campaign contributions, to perform its magic.

    • TopsyJane

      “It’s still not a win, but the R’s pulled this nightmare bill from consideration this week. They will get back to it after the recess.”

      Actually, this is a big win. It’s just not the end of the war. McConnell really wanted to get this out of the way before the recess. It also exposes a chink in Genius McConnell’s armor – he has not only had to back down but reportedly was blindsided by the unexpected backbone shown by the “concerned” members of his caucus.

      • Pete

        I too was somewhat shocked that Susan Collins actually said: “Hell, No!”

        I think her past experience as Maine’s insurance commissioner gave her some insight into the likely actual effects of the legislation.

        • Steve LaBonne

          She wants to be Governor of Maine. Yertle can’t help her with that, but voting for this atrocity surely could hurt her.

          • farin

            And having it pass would make the Governor’s job much less pleasant.

            • HowardBannister

              The protracted rollout could make her have to own the consequences of her own actions. That, right there, might give her serious pause.

          • L2P

            Why does she want to give up one of the best gigs in America to do thankless, difficult work?

            • rm

              Imagine you had to work for Mitch McConnell.

  • cpinva

    “The best conservative health policy analysis proceeds from the controversial but, I think, correct perspective that much health spending is wasted and that people do not value or benefit from insurance as much as liberal technocrats presume.”

    in a way, he’s somewhat correct, but not for the reasons he thinks. several years ago Dr. Krugman did a column comparing per capita health care costs in the US, vs the same in a dozen “first world” countries. the per capita cost in the US was 3 times the same cost in the next nearest country, with worse overall outcomes. why would this be? it would be because the rightwing Wurlitzer has convinced many doctors they’re just on the edge of being sued for malpractice. to cover themselves, they order lots of unnecessary tests which, to no one’s surprise, end up costing lots of wasted money. if you’re insured, they tend to order even more tests, just to be certain. again, wasted money, pain and time.

    but, conveniently, Douthat fails to mention this aspect of health care, underwritten in large part by insurance, that wastes billions of dollars a year. a month before she died, my wife had a severe sinus infection. took her to the dr., who checked her out, did a swab for a lab test, and then wanted her to get an MRI, to confirm it was only an infection, not a break somewhere. fair enough. however, I suggested an X-Ray first, way less expensive, and less traumatic for her. if that wasn’t sufficient, then we’d go up the scale. the X-Ray was perfectly sufficient, she just had a sinus infection, treatable with anti-biotics. the X-Rays cost me $11 out-of-pocket, the MRI would have been hundreds of times that, for the same result. there’s your wasted health dollars.

    • Jon_H11

      It’s almost as if the consumer-market framework does not lead to satisfactory outcomes for some goods and services. Inconceivable!

      • Steve LaBonne

        That word…

        • Princetonlawyer

          I think it does not mean what . . .

    • Daglock

      Considering that 1/3 of health care spending is consumed by administrative costs of the “free market health insurance” model, I suggest a starting point for cutting wasted expenditures.

      • farin

        Surely every Republican can get behind reducing corruption, waste and fraud!

        • Daglock

          You didn’t use the sarcasm font.

          • Breadbaker

            There are comments that are so obviously sarcastic that the font would be wasted on them. It would be like requiring Antony’s eulogy for Brutus to be printed in that font.

  • Mike G

    people do not value or benefit from insurance as much as liberal technocrats presume.

    Let’s survey how many of these Repukes making theoretical arguments about the value of insurance, are choosing to live without health insurance themselves.

    My money is on zero.

    • Nick never Nick

      It’s true, health insurance don’t turn us into immortal Ubermenschen, we have to be satisfied with a few more years of life and the security to make life decisions without worrying about access to health services.

  • Joe_JP

    Leah Litman‏ @LeahLitman 14m14 minutes ago

    I found a video of @LemieuxLGM blogging about arguments for the BCRA/AHCA (those are the arguments he’s smashing) http://www.lawyersgunsmoneyblog.com

    [Gif of a Hulk like creature slamming someone or something.]

    (She’s a law professor who blogs at Take Care Blog.)

    • Hogan

      That would be Loki in The Avengers.

      • so-in-so

        “I’m a GOD!”

        Wham, wham, wham. Moan

        “Huh, puny god.”

      • Joe_JP

        Thanks.

  • Nick never Nick

    Let us be fair to Megan McArdle — arriving at adulthood and discovering that you are, in fact, useless, can be a shock. Some of us deal with it by putting down our noses and grinding it out; others go back to school to try and become useful; some write, some paint, some wander the back roads and note the beauty of the spider webs on the tarweed. And, some sell out to Los Bros Koch, and spend their lives arguing that health insurance is unhealthy. It’s a wonderful world, it takes all types.

    • brad

      You’re assuming she ever had any integrity to sell.

  • smartone

    another thing not mentioned
    For a generation many have gone without health insurance and that means no health care

    to change this mindset and get people to go see doctors for annual checkups and if they have small health issues takes a while definitely more than the 7 years of Obamacare .

    once this happens then Obamacare benefits will really become apparent

    • farin

      One of the key ways Cuba offers such effective health care at so little expense is very, very aggressive efforts to make sure everyone gets yearly checkups, up to and including doctors showing up at the door and just doing it there.

      Of course, that’s why they have no freedom in Cuba and we mustn’t communicate with them.

  • Bitter Scribe

    Strictly speaking, it’s not that they want to kill you. They just don’t care whether you live or die.

    • Princetonlawyer

      No, they would highly prefer if you die before qualifying for Medicare, or, if that can’t be avoided, at the very least before becoming old, poor, and sick enough to need nursing care and qualify for Medicaid.

      These assholes understand perfectly well the skew in Medicaid dollars to nursing home patients.

  • Hondo

    I’m gonna keep coming back to this until you people believe me, damn it!
    There is no way she can honestly hold this opinion in the face of so much evidence to the contrary. She knows the limitations of the Oregon study regarding the benefit to outcomes of having Medicaid as opposed to not, and the numerous other studies that show having insurance is a definite good thing.
    The only explanation is that she has an axe to grind. She is playing for team republican because it financially benefits her, and her employer.
    How did the news media get so thoroughly infested with pundits who have fallen victim for motivated reasoning, and all in the same direction? It can’t be a coincidence. That doesn’t mean it’s a conspiracy, either. Doesn’t take an explicit order from the boss in order for them to figure out what he wants and find a way to give it to him.

  • AdamPShort

    Like so much right-wing bullshit, what makes this one so maddening is what’s true about it.

    We do know that in all probability much of what our medical system does isn’t actually useful. We have numerous examples of major failures in the system that have led to massive amounts of money being spent on medical care that doesn’t improve people’s health outcomes. This is a serious problem in the current system and only becomes a bigger problem as more and more of the system becomes publicly funded.

    The solution to this problem, of course, is to subject all treatments to effectiveness review. You may recall that the ACA included some effectiveness review provisions. Conservatives called these provisions “death panels” and said that comparative effectiveness review would involve federal bureaucrats deciding whether your grandmother gets medical care (this is the sort of the thing that COULD be true if CER were implemented in a certain completely asinine way but isn’t actually true.)

    Now conservatives are using the underlying problem – that much medical care is not effective – to justify denying your grandmother medical care.

    There’s a very important principle at stake, you see, which is

    1) More money for us
    and
    2) Fuck you

    … also on edit as Atrios says I would like someone to catalog all the various jizzdouches making the argument that medical insurance doesn’t help people and figure out how many of them choose to go without health insurance. I am guessing the answer is a big fat zero.

    • Hondo

      I might be remembering it wrong, but I thought death panels referred to the palliative care coverage that was part of the ACA until it got dropped due to all the lying republicans did about it.
      Atul Gawande wrote about the importance of having these discussion with your doc so they can help you figure out how you want to spend the time you have left, that means possibly deciding to forego extensive medical intervention to keep you alive another month.
      That was one way of making the overall system more effective. Also, ACA had measures to reduce the reliance on fee for service, and switching to paying based on actual outcomes.
      There were many other provisions in ACA to encourage more efficiency, quality, and accountability.
      These at least were steps in the right direction.
      But, we can’t have nice things when the vandals have anything to say about it.

      • sam

        Yes. This is exactly what those “death panels” were. And they monstrously lied about them in order to scare people that they were going to be herded into rooms and exterminated.

        So they dropped this completely sensible provision from the ACA.

        And look – it’s not like doctors DON’T have these conversations with their patients. But the ACA was trying to encourage the practice by simply making it a reimbursable service so that they were had earlier than when patients were already close to terminal.

  • AdamPShort

    Re: death panels:

    “Death panels” weren’t one thing. Originally when Palin said it, it was just completely something she made up, saying that there would be a panel of bureaucrats deciding who was worthy of care.

    When pressed, her campaign (such as it was) pointed to the provisions for end – of -life counseling, which weren’t essential to the bill and thus were removed.

    Then the Washington Times and Fox News and other conservative need outlets started calling all sorts of things death panels. For a while IPAB was a death panel; then comparative effectiveness review was a death panel.

    In the end ANYTHING that might cause someone to be denied care was at some point deemed a death panel.

    • Daglock

      I’d be more expansive and state any regulatory or policy decision which favored one course of care over an alternative course of care was deemed an assault on freedom, liberty, and the ‘Murican Way (move to Norway, a socialist hell-hole, you libtard) that would result in government bureaucrats deciding who lived and who died, i.e., a death panel.

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