A Handy Guide To GOP Healthcare Doubletalk

<"Warning! Warning! Danger! Danger, Will Robinson!">

A live plant guards the entrance of U.S. Rep. Fred Upton's district office. Upton is among the many Republicans who have refused to face their constituents, after passing the revived (and more draconian) American Health Care Act. 

No question about it. The details of health care are maddeningly difficult, as our Grifter In Chief's classic response suggests ("Nobody knew health care could be so complicated"), after the American Health Care Act's original demise. We here at Ramen Noodle Nation wholeheartedly agree, though not for the reasons that the Trumpkins might expect.

Republicans are resourceful, at twisting the language when it suits them. Really, it's a tradition that harks back to the Reagan era, one that's returning in full force amid the hurricane of blowback that greeted the U.S. House of Representative's revival of the American Health Care Act. 

One of those tactics is the use of pleasant-sounding, Orwellian wording to conceal the AHCA's scarier provisions (and GOP assertions that don't pass the laugh test). So, without further ado, here's a quick scorecard to understanding what they really mean, once their lips start moving at lightning speed.

Access. Noun. What Republicans claim they're trying to preserve under the American Care Health Care Act. "Nobody dies because they don't have access to health care." U.S. Rep. Raul Labrador (R-Idaho), during an especially testy town exchange recently with his constituents.

Translation: "I have access to buying a $10 million home. I don't have the money to do that." U.S. Senator Bernie Sanders during Tom Price's confirmation hearings for Health and Human Services Secretary.

Affordable. Adjective. An alleged goal of the American Health Care Act: "It returns control of health care back to the states and restores the free market so Americans can access quality, affordable, health care options that are tailored to their needs."

Translation. Check with the 23 million people estimated to lose what benefits they've gained, in case this nonsense ever becomes law. 

Choice. Adjective. Another stated goal of the American Health Care Act: "The AHCA will deliver the control and choice individuals and families need to access health care that's right for them."  

Or, as House Speaker Paul Ryan couched it, in a USA Today op-ed last March: "That's why we must end this law -- repealing it once and for all. But rather than going back to the way things were, we must move to a better system that embraces competition and choice and actually lowers costs for patients and taxpayers."

Translation. See "affordable." Enough said on that one!

Flexibility. Noun. The quality of bending easily without breaking, ability to be easily modified, or, willingness to change or compromise. (Do any of these terms sound like the Republican approach to dealing with public opposition?)

Another stated goal of the American Health Care Act, as U.S. Rep. Jackie Walorski (R-South Bend) indicated in a statement released in March: "With the American Health Care Act, we are delivering on our promise to the American people to repeal Obamacare and repair our nation's health care system. These improvements will better help individuals and families access affordable health care and give states greater flexibility to implement innovative reforms like those in Indiana."

Translation: This post from Healthcare In America nails it: "Conservative lawmakers want maximum flexibility in health insurance. The free market, rather than the government, should decide if those plans are buying. The Affordable Care Act, on the other hand, set strict guidelines for the types of plans insurer could offer. It put a floor on maximum annual and lifetime insurance benefits and required all insurers to cover ten essential health benefits. Insurers could no longer mini-med plans or exclude specifc types of benefits, like maternity care, from plans.

"Instead of social and financial risk protection, their focus is on promoting personal responsibility. People should know, and purchase, their needed level of insurance. If people miscalculate that risk, then they should have done a better job of figuring out what they needed. That's the definition of personal responsibility. In line with this principle, the AHCA encourages plan flexibility by allowing states to opt out of the ten essential health benefits and allowing insurers to reinstate lifetime limits."

Reform. Adjective/Noun/Verb (depending on usage). Yet another stated objective, as Ryan outlined in March, following initial Congressional Budget Office scoring of the American Health Care Act: "This report confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care. CBO also finds that this legislation will provide massive tax relief, dramatically reduce the deficit, and make the most fundamental entitlement reform in more than a generation."

Translation: See links below. Enough said there, too!

Risk-Sharing/Risk Pool. Verb/Noun. What Republicans want poorer and low-income Americans to accept in exchange for losing Medicaid benefits, whether current or expanded. 

"Running a high-risk pool is not cheap, but it is likely cheaper than the major alternatives: on the one hand, imposing a universal government system like Obamacare or single-payer, or, on the other hand, covering the costs of these patients through medical bankruptcies and emergency room visits." (The Federalist: "Relax: Nobody Will Drown In Trumpcare's High-Risk Pools.")

Translation: Numerous states tried this approach before the Affordable Care Act's passage, with one outcome, as the Center for American Progress notes: "High-risk pools are expensive, and they have a history of being underfunded both before and after the ACA. Insufficient funding meant that patients seeking high-risk pool coverage encountered waiting lists, sky-high deductibles, and premiums double those of standard rates. Given the enormous funding shortfall looming for high-risk pools in the AHCA, there's no reason to think this time would be different."

Skin In The Game. Catch Phrase (attributed to super-investor Warren Buffett). How Republicans justify their spiteful approach to public policy. "It just has to be a system where those of us who consume health care as patients have more understanding of the true costs, have more input as what the decisions are, frankly, that we have some skin in the game." Congressman Bill Huizenga, of Zeeland, explaining his stance after an equally testy town hall in Baldwin.

Translation: :"As Republicans rush to vote on their latest ObamaCare repeal-and-replace plan, it appears to still include an item exempting members of Congress and their staffs from losing the healthcare bill's popular provisions. 

"After Vox reported that the bill agreed to still include the exemption for lawmakers, Rep. Tom MacArthur's (R-NJ) office said separate legislation would close that loophole." (The Hill, 5/03/017)

Until that day comes...sounds very much like a case of, "Your Skin. Our Game."

Soft Landing. Noun. A controlled landing of a spacecraft during which no serious damage is incurred. 

A popular metaphor making the rounds lately among Republican Senators like Rob Portman, of Ohio, as they sound ready to throw benefits of the Medicaid expansion under their well-heeled bus: "I think there ought to be a soft landing, a glide path, where you don't have the cliff the House provides in 2020."

Translation: We'll wait until, say, 2023 or 2025 to give you that push of the plank. Too many people are paying attention right now. We'll stick it to you once we're sure that the threat to our job has blown over.

We welcome further updates. --The Reckoner

Links To Go (Hurry, Before Trumpcare
Kicks In, And Your Skin's Torn Off In Their Game):
Healthcare in America: What Liberals Get Wrong
About The Republican Approach To Health Insurance:
https://healthcareinamerica.us/what-liberals-get-wrong-about-the-republican-approach-to-health-insurance-8b4b93fae6b3

The Atlantic: How The American Health Care Act
Leaves Near-Elderly People Behind:
https://www.theatlantic.com/politics/archive/2017/03/ahca-trumpcare-older-sicker-voters/519423/

The Atlantic: The AHCA's Tradeoff: Giving Up
Vital Care To Get Tax Cuts For The Rich:
https://www.theatlantic.com/business/archive/2017/03/ahca-economics/519498/

The Huffington Post: All Of UsMust Resit These 4 Threats To Medicaid:
http://www.huffingtonpost.com/entry/all-of-us-must-resist-these-4-threats-to-medicaid_us_592492e6e4b0dfb1ca3a0f11

Benefits Back On The Chopping Block: Now Is Not The Time To Sit On The Fence

<"The ice age is comin', the sun's zooming in:
Engines stop running, the wheat is growing thin...>

<i.>

They've done it again. The Republican ideologues in the House of Representatives...who couldn't agree on the finer details of screwing the poor (and their low- to moderate-income peers)...jump-started their innocuously-titled monstrosity, the American Health Care Act (AHCA), in all its ghasty glory, by a 217-213 vote today. As expected, the measure passed along party lines, with 29 Republicans voting no, and no Democrats voting for it. The political football back to the Senate, where the math hasn't changed: you still need 60 votes, including eight Democrats, to actually pass this so-called piece of legislation. We'll see how well that scenario plays out.

However, I'm not going to spend time rehashing the ugliness of the AHCA, which is almost stupefying, in terms of who it rewards (the already insanely wealthy) and punishes (seniors,  via the "age tax" that insurers imposed before the Affordable Care Act (ACA); the poor, via the attempted conversion of Medicaid into a block grant program, or the imposition of high-risk pools, which failed spectacularly in states that tried them iduring the pre-ACA era). You can read the links below to see how the screw will bore through your back. Trust me -- no matter who does the analyzing, it's not a pretty picture.

Nor will I revisit the familiar pro and con arguments about the ACA's impact on the average person. Obviously, major issues that need correcting -- starting with the sky-high deductibles ($6,000 and $12,000? who were they kidding?), and double-digit rate increases that stoked resentments against the law. Now that people realize what they might lose, support for the ACA has shot up. If the Democrats ever regain majority control, they'll need to address these issues -- but that's another discussion for another day. If the law vanishes, that discussion is academic.

There's something downright surreal about the House's race to strip so many millions of what coverage they've gained since the ACA passed in 2010. Somewhere in his special little air-conditioned room in Hell, the late, discredited East German Communist leader, Erich Honecker, is high-fiving his equally grimy colleagues, as they observe the anticsnow going on in Washington: "Ja, ja, see? I told you so! I told you so!"

No, today, as we hold our breath, once again -- I'm going to focus on the people who, even now, after all the picketing and protesting, keep saying things like, Give him (Trump) a chance." "He doesn't really mean what he says." "He probably won't finish out his term." "It doesn't matter, and it doesn't affect me." "Whatever he does, we can overturn it at some other time." To all of those excuses, I offer a simple rejoinder: Now is not the time to sit on the fence, and here's why.

<I think we've all seen this movie before...>

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Maybe you voted for Trump, thinking he really is some kind of  populist, waiting to tap his inner Bernie Sanders? There's a classic saying in business that past behavior is the best predictor of future behavior. Granted, Herr Trump zigzags constantly, but the few proposals that he's tried to advance --the AHCA, the massive social services cuts envisioned in his so-called budget, or the proposed tax cuts that would, effectively, soak the rich dreams to unimaginable new heights -- hail from the ultra-right playbook. Yet he's trying to jam all these things down our throats,with an approval rating that hovers somewhere in the low 40s. I don't feel like keeping quiet as he rolls out these evil science experiments. And neither should anybody else.

Maybe you take Trump for the latest clown who'll limp out of Washington with his tail between his legs, without any substantive achievements? Perhaps, but he can still wreak plenty of havoc by default. The best chance to check him  -- the 2018 midterm elections -- is a gut-wrenching 18 months away. Unless we lay the groundwork now, the Democratic dreams of recapturing one (or both) Houses of Congress will amount to no more than that. Ask the rivals who watched Trump stumble in Iowa last year, only to see him walk off with the nomination. Ask them what happens when you don't take a looming threat seriously.

Maybe you're unwilling to stand up, because Trump won't survive the impeachment process, and you somehow won't be affected? Impeaching Trump leaves us vulnerable to his equally batshit crazy VP, Mike Pence -- the same "compassionate conservative" who also presided over massive public health cuts as governor of Indiana. Putting someone like him at the top of the pyramid doesn't buy us relief; protest does, at least some degree, if only because it serve as a rude interruption of Trump's and Pence's narcissisitic fantasies ("Who cares what the media claims? They love me!"). And don't think you'll slip under the radar somehow. How many employers will continue offering the same kind of insurance -- or, for that matter, any kind of insurance -- if the AHCA actually becomes law?

Maybe you're counting on someone else to speak their mind, because you think the damage can be undone later? That scenario only becomes probable if Democrats capture the U.S. House and Senate, which nobody in their wildest dreams is floating right now (Most of the smart money is focused on regaining the former body). Part of the reason we're in this fix is because everybody waited for someone else to do the right thing. The progressives waited for the Democratic establishment to hear them out. Didn't happen. The voters returned the House to GOP control, hoping for relief from ACA premiums. Didn't happen. Trump's rivals, then Hillary Clinton, waited for him to stumble, and commit political hara-kiri. DIdn't happen. 

See where that logic gets us? No matter what rationalization you choose, the result is the same, as the British abolitionist William Wilberforce once observed: "Having heard all of this you may choose to look the other way but you can never again say you did not know." No matter what happens with the House vote today, whatever protesting we do must continue, and we must continue to drive home the message. Now is not the time to sit on the fence. --The Reckoner

Links To Go (Hurry, Before
They Yank The Coverage Rug For Good):
Center For American Progress:
The Upton Amendment To The ACA
Repeal Bill Will Have Almost No Effect:
https://www.americanprogress.org/issues/healthcare/news/2017/05/03/431827/upton-amendment-aca-repeal-bill-will-almost-no-effect/

Huffington Post: Jimmy Kimmel's Humanity
Underscores GOP's Heartlessness Toward The Poor:
http://www.huffingtonpost.com/entry/jimmy-kimmel-mo-brooks_us_590882a9e4b05c397682861c

Los Angeles Times: All The Horrific Details
Of The GOP's New Obamacare Bill: A Handy Guide:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-repeal-20170504-story.html

Los Angeles Times: Seven Ways
The GOP's Obamacare Repeal Bill
Would Wreck Your Healthcare:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-gop-healthcare-20170314-story.html

Los Angeles Times: The GOP Isn't Replacing
All Of Obamacare -- Just the Parts That Work:
http://www.latimes.com/opinion/editorials/la-ed-gop-obamacare-replacement-plan-20170306-story.html

Poverty Level Republicans (You Gotta Love 'Em)

You've probably seen this book making the rounds at one time or another. Originally published in 1937, Hill's purported rags-to-riches instruction manual has entered the inner ring of all-time best-sellers (reportedly racking up some 20 million copies at the time of his death in 1970). Of course, it's a tad light on specifics, though Hill apparently believes that visualization is sufficient to get the heavy lifting done: "You may as well know, right here, that you can never have riches in great quantities unless you work yourself into a white heat of desire for money, and actually believe you will possess it."

It's not a stretch to imagine such disparate characters as the Beach Boys' lead singer, Mike Love, corporate raider T. Boone Pickens and the late "Queen Of Mean", Leona Helmsley, reading such passages aloud to themselves, nodding their approval: "Some day, I'll stand at the top of the pile...and when I do, there won't be any stopping me."

My introduction to Hill's book came as a teenager, after my late father -- who was a contractor -- brought it home from a job one day, shaking his head. When I queried further, it turned out that Dad's latest client had practically pressed the book into his palm, suggesting that he give Hill's ideas a try. What did Dad have to lose? Besides, once he finished reading it, he wouldn't avoid the only logical conclusion...and become a Republican, since they were the cash-endowed ones, right?

However, my dad had no interest in joining The Party Of No, let alone voting for any of their so-called representatives...especially after doing jobs here or there for members of the local GOP hierarchy, who'd often treated him (as he told me) "like just another dumb laborer"...even though he'd largely educated himself after the Second World War ended, primarily by reading just about every book he could get his hands on. Suffice to say, Mr. Hill's masterpiece sat gathering dust on the shelf in our den, and my dad never broached the subject again.

Dear Old Dad's encounter with Napoleon Hill's ideology ("What the mind of man can conceive and believe, it can achieve") marked my first encounter with a new phenomenon: The Poverty Level Republican.  The above graphic sums up the distinction cleverly enough, but for those who just tuned in, it's the opposite of the image typically associated with the Elephant Set: those grubby little "One Percenters" that we all keep hearing so much about.  However, I don't hate them for voting Republican, because there's a rational undercurrent behind such choices: they're only looking after their own best interests (such as reducing their individual tax burden to infinitesimal levels...but I digress).

I began seeing more Poverty Level Republicans after starting college. Overall, they tended to occupy the bottom or lower middle class rungs of the American economic ladder, which didn't dim -- not for a second -- their admiration for such up-and-coming conservative spear carriers as our newly-elected fortieth president, Ronald Reagan, or his eager acolytes (including supply-side gurus like Arthur Laffer and Milton Freidman, for example). They boasted a comically exaggerated self-confidence in their own bootstrapping abilities, even if that "some-day-my-ship-will-come-in" moment seemed an awfully long way off (as in, "dig-up-John-Lennon-to-reunite-the-Beatles" or "Finding-Jimmy-Hoffa's-perfectly-mummified-body-in-an-oil-drum-in-Southfield" territory).

However, you never heard any resentment voiced towards a political system that had only just begun its hellbent descent toward record levels of inequality. Hell, they wanted to become rich -- or, at least, well to do -- so why vote for anyone trying to interfere with the emerging Trickle-Down way of doing business? At the same time, the Poverty Level Republicans I met couldn't wait for the day that Reagan would finally push those mooching welfare queens right off the couch, and into the cold, where they so rightfully belonged.

If that meant putting off social equity a little bit longer, so be it. If that meant having to brown bag it a couple more times per week, so be it. If that meant stitching together two, three or even four part-time jobs to cobble enough money for tuition, housing or meal plan rates that were already approaching stratospheric levels, so be it. If that meant putting off major life decisions like getting married, or buying a house, to pay back those student loans -- which were also ratcheting into outer space -- so be it.

Whatever personal difficulties lay ahead, Poverty Level Republicans just confidently asserted that their personal boom time lay just around the corner (even if they didn't know which corner)...or President Reagan would give one of those folksy, but blistering fireside chats on TV, and whip those pinheads in Congress back into line...then everything would work out somehow, in its own surreal American way. You had to love optimism like that, even if no empirical evidence suggested the remotest chance of the above-mentioned scenario happening.

One of the tragic ironies of Barack Obama's presidency, it appears, is that some of his most ardent haters are the "99 Percenters" that he's trying to save -- even if it's from themselves. A recent Yahoo News story that Your Humble Narrator came across puts the whole situation nicely in perspective, focusing on why those "red state" Kentuckians can't bring themselves to support Obama.

I won't belabor the contents but what's funny (and sad) is the deepest hatred coming from the people with the least money -- and the most to lose. As one Kentucky resident (Eric Miller) observes, "If there weren't government programs, it would be a ghost town." Yet, in the same breath, he states: "The Republicans, they are the ones that know...raised up like we have, you know. Know what it's like, what we need, what shouldn't been taken away."

Such comments are downright surreal, especially when you consider the Republican-dominated House of Representatives' attempt last year to cram steep food stamp cuts down the throats of gents like Mr. Miller, who gets by on $380 per month.  Congress's recent decision to let additional unemployment extensions expire -- "not with a bang, but a whimper," as T.S. Eliot would say -- is another indicator of how the political class feels about the pesky 99 Percenters they claim to represent so ardently.

At best, they view them as a nuisance to fool into re-electing them; at worst, they harbor a deep-seated hatred and hostility toward the Eric Millers of the world. After all, various members of the Elephant Set have openly boasted of "starving the beast" as a strategy -- the theory being, if you continue gutting social programs past the point of no return, the poor will eventually shrivel up and blow away, just like all those tumbleweeds you've seen lately at dead malls across America. 

So why do the Eric Millers of the world, then, vote for the people who seemingly stay up around the clock, thinking of new ways to keep down?  Various explanations have been trotted out to try and account for the Poverty Level Republican phenomenon, which you can read below, too. Speaking from experience, however, I personally see little or no point in trying to explain bullshit for bullshit's sake. In my time, I've seen a more mundane phenomenon at work.  

People display a remarkable knack for doublethink.  They rail against "welfare moochers," even they collect food stamps and cash assistance themselves. They vote against ballot proposals and millages -- even renewals, which are considered no-brainer propositions in municipal circles -- yet are the first to scream for the services that have long evaporated  They fight like a wounded bear cub for whatever government benefits they collect, even as they pay lip service to that moth-eaten cliche that's all too frequently trotted out during the latest national debate ("America must learn to live within its means").

Contrary to what some of my left-of-center friends think, I don't believe these inconsistent attitudes reflect a desire to get rich quick anymore -- hell, with so many people broke and leveraged to the hilt, the New American Dream is simply getting out of debt.  The simpler explanation comes down to a quote attributed to Mark Twain, though I haven't managed to track down its source: "Few political systems are as ingenious as getting people to vote against their own best interests as this one."  

That's as good an explanation as I've heard for the current administration's struggles. When Obama came to Capitol Hill in 2008, he hoped, prayed and stated that -- somehow, somewhere, doggone it -- people would line up behind him, whether they agreed with him or not, for the sake of the nation. It's the kind of kabuki theater that causes seasoned political journalists to piss their pants with laughter, but apparently, our Commander In Chief really believed that scenario would happen.

Alas, such dew-eyed dreamin' and doe-eyed optimism collided head-on with The Party Of No...and their accomplices, the Poverty Level Republicans. Meanwhile, the collateral damage continues, with everyone else paying the price. In short, it's business as usual. --The Reckoner

Links To Go (And Get Depressed By):
AppalledByLePage.com: Against Their Own Interest: Why The Rural Poor Vote Republican
http://www.appalledbylepage.com/2012/10/18/against-their-own-interest/

DemocraticUnderground.com: Poor Kentucky Has No Stomach For Obama
http://www.democraticunderground.com/10024955559
[Note: This is only a partial recap, since the link apparently doesn't exist anymore -- and I don't want the Copyright Cops chasing me down if I post it all here.  Anyway, the resulting discussion should give you a good feel for the actual content.]

The New York Times Opinion Pages: Moochers Against Welfare
http://www.nytimes.com/2012/02/17/opinion/krugman-moochers-against-welfare.html