The eternal agony of being Paul Ryan

It’s a tough job being the Republican Speaker of the House. You get all the mucky tasks. Some days it’s inveighing against Bill Clinton’s extra-marital affair while conducting one of your own behind the back of your cancer stricken wife, other days it’s standing on stage to pledge support for the man that you just described as the “textbook definition of a racist.” No doubt the position description lists “absolute spinelessness” and “grating lack of shame” as the primary qualifications.

At least in that regard, whatever mold it was that Paul Ryan formed in was built on spec. As a champion of hypocrisy and bright-eyed lying, he’s unparalleled. Just this last week, faced by a voter who earnestly wanted to know why the Republicans would repeal Obamacare without a replacement in place, Paul Ryan looked towards his roots and lied like a champion.

No, he said, the Republicans would never do that. With a smile on his face, and a sly shake of his head, Paul Ryan stared the truth down like an old-west Sheriff come out to warn wayfaring ruffians that they weren’t welcome in these parts. It’s a performance that might have fooled someone with absolutely no knowledge of American politics or recent history. Failing that, he might have put one over on an alien that is totally ignorant of how humans interact. But, lest we be drawn in ourselves, let’s examine the record.

Not twenty-four hours before Ryan’s performance, the Senate had voted to take the first step necessary for repealing Obamacare by passing their continuing resolution for next year’s budget. Alongside the humdrum of yearly outlays, the Republicans included parliamentary provisions which make it impossible for Democrats to filibuster healthcare repeal. At the same time they rejected an amendment which would prohibit cutting medicare, medicaid or social security. No matter what Ryan might say about simultaneous repeal and replacement, the fact of the matter is that repeal is ongoing while replacement remains purely within the realm of speculation.

Besides lying about the schedule for the repeal and uncertain replacement of Obamacare, Ryan also spent no small measure of time happily lying about Obamacare itself. First he said that it was a rotting edifice which is slowly decaying of its own. Were that true, Republicans could hardly be faulted for clearing away the rubble. It isn’t though. In the last year, 6.4 million newly insured Americans have signed up for health coverage through Obamacare sponsored exchanges, about a 7% increase from the previous year. In fact, the states which boasted the most new enrollments were all won by Trump. Maybe that explains Republican haste to do away with health coverage quickly, so that their voters never get to know what they’ve missed.

[read more about the impact of Obamacare here.]

Ryan then said that Obamacare was fundamentally flawed as an insurance scheme because it was facing down a “death spiral.” Perhaps an impolitic term to use in response to a man who has just survived a serious disease, but according to Ryan the term is actuarial in origin and it describes the problem that arises when healthy people are not buying into insurance pools. Because the very principle by which health insurance remains sustainable depends upon healthy people buying in at a rate that can support the expensive care of sick people, a lack of buy-in dooms any plan. That’s a truism though, and uninteresting.

Where Ryan finds his stride is in the style by which he begins with a true statement (in this case the insurance marketplace equivalent of stating that the sun is round) before skipping directly to as asinine conclusion (that Obamacare is necessarily doomed). It’s an insidious technique because the opening truism acts like the flourish of a magician’s hands. By beginning with something basically true before leaping directly to a conclusion that is only tangentially related Ryan skips straight past the argumentation that actually connects the former to the latter, perhaps hoping that we’ll fill in the blank ourselves or not notice the sleight of hand at all.

It’s a cheap trick though, and it falls apart upon examination. Leaving aside the fact that the described circumstance isn’t so much an argument against Obamacare as an argument for raising the penalty for going without insurance, Ryan’s unsaid implication that the Republican plan would solve this is an atrocious lie. The single aspect of Obamacare which has attracted the most vitriol over the last eight years was the individual mandate. Though I’m not sure if they ever settled on a point of rhetoric as to what the individual mandate actually was, from the Republican point of view it certainly lay somewhere between the imposition of dictatorial rule and wholesale gun seizures. They have promised unequivocally that whatever they cook up, there will be no requirement to buy insurance.

In other words, Ryan is arguing that Obamacare (with its individual mandate requiring everyone, including the healthy, to buy insurance) is fatally flawed because the insurance pool is too small to support those with pre-existing conditions or other expensive ailments. And, at the very same time, he is proposing an as yet undefined fix which will remove the requirement that everyone buy into an insurance pool while somehow also expanding it. His contention, apparently, is that healthy people so resent the idea of being required to buy expensive insurance that they will refuse to do so out of spite, but if given the option to buy equally expensive insurance of their own free will, they will jump at the opportunity.

No, actually he’s not saying that. Really, he’s just hoping you won’t dwell too long on the logic of it, because like any good magician he knows that the trick falls apart as soon as you’ve gotten a peek behind the curtain. It’s on this same principle that he confidently cited Washington State’s high-risk insurance pool as an example of how great Republican lead health reform would be in a world without Obamacare. He’s certain that you won’t bother to look up the fact that the same insurance pool nearly collapsed in the early 90’s as a consequence of policies that the Republicans are now touting as the “solutions” to our healthcare woes.

However, as reported by David Gutman in the Seattle Times, that early foray into Republican brand healthcare reform brought woe above all else. Much like the politics around Obamacare, this early Washington plan expanded medicare and protections for those with pre-existing conditions at the cost of mandating that every individual buy into insurance. Soon after, Republicans rode a wave of resentment to their largest state-house margin ever, in no small part because of their persistent promise to do away with the individual mandate.

And this they did, while all the while promising that the more popular provisions like protections for those with pre-existing conditions would remain. But, much like Ryan and the current crop of Republicans are doing now, those Republicans were promising the stars when they knew full well that the best we were gonna get was something a little closer to Earth.

In this case, without the individual mandate local insurers had no way to keep up with the cost of caring for sick patients. The “death spiral” which Ryan predicts as the consequence of an individual mandate was in fact the result of its removal. The largest insurer in the state lost $120 million before quitting the individual policy business altogether, and within four years 17 of the 19 insurers in the state had called it quits. The next year it was no longer possible to buy individual insurance even if you wanted to.

So, whatever Ryan and the Republicans might say about health savings accounts and driving down premiums, know this: it won’t matter how much you can afford to buy when there’s nothing for sale. The Republican plan has been tried, and it failed. Repealing Obamacare without a plan in place for a robust replacement will mean higher costs. Not only increased monetary expenses coming from an uptick in emergency room visits for what could have been routine or preventable care, but also the extreme social costs that we will be burdened with by premature deaths.

Ryan, with his glimmering eyes, will tell you otherwise. Don’t believe him. He knows the truth, but, unwilling to admit that he is simply disinterested in whatever fate might befall those who cannot afford or acquire health care, Paul Ryan turns time and again to lies.

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