Purity spats don’t help Democrats win policy fights. Just sayin’…. (More)

“All they have to do is dust off how they did business before Obamacare”

That’s what Health for Rich Humans Services Tom Price said yesterday in response to insurers’ objections that the Senate Wealthcare Act would send the individual market into a death spiral:

“It’s really perplexing, especially from the insurance companies, because all they have to do is dust off how they did business before Obamacare,” Price said, referring to an amendment proposed by Sen. Ted Cruz (R-Texas) that would allow insurers to resume sales of policies that leave out key benefits, such as prescription drugs or mental health treatment.

“A single risk pool, which is what they’re objecting to, is exactly the kind of process that was – that has been utilized for decades to care for individuals,” he added.

But the pre-ACA health insurance market was a mess, precisely because it wasn’t a “single risk pool.” Unless you worked for the federal, state, or local government – or for another employer big enough to have the economic clout to demand and get true “community rating” – you were your own “risk pool.” Insurers could, and did, set premiums based on your individual risk factors: age, preexisting conditions, lifestyle, etc. That meant health insurance was unaffordable for one-fifth of American families. If you got seriously injured or ill, you went to the hospital and hoped you could pay for it.

Even if you did have insurance, the very first thing your insurer did when you got sick or injured was to look for any possible reason to refuse to pay for your treatment. Did you disclose that risk in their application questionnaire? If not, they’d look for a way to cancel your policy retroactively, known as rescission, although of course they wouldn’t refund your months or years of premiums. Or they’d call it an undisclosed preexisting condition. Or they’d object that, while you went to an in-network hospital, the doctors who treated you weren’t on their in-network list. Or whatever other excuse they could find.

If you had no insurance, or if your insurance refused to pay for your treatment, then you often went bankrupt … and the hospital and doctors and other providers passed the cost of your treatment off on their other patients.

That was “how they did business before Obamacare,” and that’s what Price wants to see again. And he doesn’t plan to stop with just the Wealthcare Act:

“What we’re doing over at Health and Human Services is going through all the rules and regulations that were promulgated pursuant to the Affordable Care Act,” he said. “Those places where it said the secretary shall or secretary may, 1,442 times, and we’re looking at those and asking the question does this help patients or does it harm patients?  Does it increase costs or does it decrease costs? And where the answer is wrong, we’re going to move it in a much better direction.”

Of course he doesn’t explain what he means by “help patients” or “harm patients,” or for whom it might “increase costs or … decrease costs.”

Because what he means by “help patients” or “harm patients” is whether it helps or harms them when they sign up for a plan, not when they get sick or injured. If the plan seems cheap, it “helps patients” … even if it won’t cover them when they need it.

And what he means by “increase costs or … decrease costs” is for rich people. There is nothing in Price’s plans that limits how much hospital or doctors or labs or pharmaceutical companies can charge you. He just wants to make sure they charge you personally, rather than spreading the costs among other insurance customers (through community rating) or – worse! – spreading the costs to rich people (through tax-supported programs).

Oh, and if you buy one of those Cruz Amendment plans – low premiums, huge deductibles, skimpy coverage – the Senate Wealthcare Act says you won’t qualify for “continuous coverage” if you try to buy a comprehensive plan:

Buyers of cheap Cruz plans would be locked out of the insurance market if they get sick. A little-noticed aspect of the Cruz proposal is that the cheap plans it allows would not qualify as legitimate insurance coverage under the GOP’s “continuous coverage” rules.

Those rules, embodied in both the House and Senate GOP repeal bills, guarantee coverage for preexisting conditions as long as the buyer maintains insurance coverage without a break of longer than two months. Under the Senate bill, anyone with such a lapse would face a six-month waiting period for new insurance before the preexisting condition guarantee would be effective.

That means that individuals who get sick and discover that their Cruz plan won’t cover their illness wouldn’t be able to buy full coverage for at least six months. It’s a classic bait-and-switch, but you won’t hear it being bragged about by Senate Republicans. They don’t really want you to know.

Of course they don’t want you to know that. They want to talk about “giving you choices” … as if any of us has the expertise or psychic ability to predict exactly what injuries and illnesses we’re likely to get. Because if you can’t predict your injuries and illnesses, then you can’t make an informed choice about what health insurance coverage you’ll need.

“Nostalgia for a bygone era, when the real thing was messier and more compromised than the sanitized historical memory”

The health care debate highlights the importance of policy and, specifically, the importance of details. Democrats’ opposition to the Wealthcare Act is grounded in moral principles, yes, but that opposition gets energy – and brings out protests and voters – by the real-life consequences of the GOP’s policies: a return to the days when families had to decide whether to get treatment or buy groceries, to begging friends and family and neighbors to help pay for a chronic condition because you’ve exceeded your annual or lifetime coverage limits, and to medical bankruptcies that passed on those unpaid health care bills to other patients. Ultimately – beyond money – affordable, quality health insurance is about living or dying.

We could focus on hard policy questions like these, or we could argue about who’s really a “liberal” and who’s merely a “neoliberal”:

The neoliberalism of the 1980s and 1990s has faded into memory, as its adherents failed to settle on a coherent set of principles other than a general posture of counterintuitive skepticism. (Peters’s new ideological manifesto, We Do Our Part, only mentions neoliberalism once.) But the term has been used to mean different things at different times, and it has returned to American political discourse with a vengeance. Then, as now, it is an attempt to win an argument with an epithet. Only this time, it is neoliberal that is the term of abuse.

And the term neoliberal doesn’t mean a faction of liberals. It now refers to liberals generally, and it is applied by their left-wing critics. The word is now ubiquitous, popping up in almost any socialist polemic against the Democratic Party or the center-left. Obama’s presidency? It was “the last gasp of neoliberalism.” Why did Hillary Clinton lose? It was her neoliberalism. Paul Krugman and Joseph Stiglitz? Neoliberals both.

As Jonathan Chait notes at that link, even liberal icon Sen. Elizabeth Warren is now sneeringly dismissed as a “neoliberal” … I guess because she supported Hillary Clinton instead of Bernie Sanders.

I found this passage in Chait’s essay especially noteworthy:

The ubiquitous epithet is intended to separate its target – liberals – from the values they claim to espouse. By relabeling self-identified liberals as “neoliberals,” their critics on the left accuse them of betraying the historic liberal cause.

Indeed, the appearance of the “neoliberal” epithet in a polemic almost axiomatically implies a broader historical critique that has been repeated many, many times.

Its basic claim is that, from the New Deal through the Great Society, the Democratic Party espoused a set of values defined by, or at the very least consistent with, social democracy or socialism. Then, starting in the 1970s, a coterie of neoliberal elites hijacked the party and redirected its course toward a brand of social liberalism targeted to elites and hostile to the interests of the poor and the working class.
The Democratic Party has evolved over the last half-century, as any party does over a long period of time. But the basic ideological cast of its economic policy has not changed dramatically since the New Deal. American liberals have always had some room for markets in their program. Democrats, accordingly, have never been a left-wing, labor-dominated socialist party. (Union membership peaked in 1955, two decades before the party’s supposed neoliberal turn, and has declined steadily since.) They have mediated between business and labor, supporting expanded state power episodically rather than dogmatically. The widespread notion that “neoliberals” have captured the modern Democratic party and broken from its historic mission plays upon nostalgia for a bygone era, when the real thing was messier and more compromised than the sanitized historical memory.

Over at Lawyers, Guns and Money Scott Lemieux agrees and disagrees with parts of Chait’s analysis. I have no doubt that, over the coming days and weeks, others will weigh in on who is really “liberal,” who is merely “neoliberal,” who is “leftist,” and what those terms “really” mean.

But here’s my nutshell, because squirrels like things in nutshells. The history of the Democratic Party is indeed messy, and that messiness is not only because of changing coalitions such as Dixiecrats fleeing to the GOP. Most of that messiness is because the Democratic Party has – throughout our history and certainly since the New Deal era – been about solving real-life problems and dealing with real-life consequences. That means policies, with all of their messy-but-essential details.

The people who want to debate “liberal,” “neoliberal,” “leftist,” and “progressive” can do it without me. I’ll be advocating policies to address real-life problems … like helping people get and keep quality health insurance.


Photo Credit: Getty Images


Good day and good nuts