The terror of death panels has returned to Washington. This time, it’s the Democrats claiming “people will die” if a Republican health care bill passes.
The Affordable Care Act (ACA, or “Obamacare”) expanded Medicaid enrollment, and the House and Senate GOP bills would partly roll back that expansion. The bills would also eliminate taxes created by the ACA and reduce incentives for those ineligible for Medicaid to purchase private policies. Fewer Americans would have insurance, with indeterminate effects on the health of those who lose or decline coverage.
For the record, I’m not a fan of either the House or Senate GOP bills. I suspect they could further destabilize insurance markets already shaken by the ACA’s shortcomings. But critics’ attacks on the GOP bills are as overwrought and destructive as Sarah Palin’s 2009 “death panel” accusation. Now, as then, hyperbolic rhetoric derails civil discourse and obscures legitimate concerns.
Regarding the GOP bills: Sen. Elizabeth Warren, D-Massachusetts, said, “These cuts are blood money. … People will die.” Sen. Bernie Sanders, I-Vermont, declared Republicans “should be reminded every day that 36,000 people will die yearly as a result.” Hillary Clinton tweeted: “Forget death panels. If Republicans pass this bill, they’re the death party.” The American Prospect wrote, “The bill is merely a vessel for lobbing more big money to folks at the tip-top.” Kurt Eichenwald, senior writer for Newsweek tweeted (and later deleted), “I hope every GOPr who voted 4 Trumpcare sees a family member get a long term condition, lose insurance, & die.”
Two principal problems with this invective: First, the predictions of massive deaths are extraordinarily dubious. Second, impugning adversaries’ motives and wishing them ill is corrosive. (Neither party has a monopoly on such practices.)
None of this means debate must be prissy. Public policy often determines life and death, directly and indirectly. It’s OK to argue that your opponents’ plans will kill more than your plans. But if you can’t publicly spar over such mortal calculus and share a pleasant cup of coffee afterward, you probably need to temper your arguments.
Here are some thoughts on the Medicaid controversy.
Some conservatives argue that enrolling in Medicaid is worse for your health than being uninsured — largely on the basis of one interesting, but anomalous, medical school study. A milder claim says Medicaid, while not harmful, isn’t terribly useful, either — based heavily on the landmark “Oregon Experiment” that detected few health improvements in those gaining coverage under the state’s Medicaid expansion. Look, Medicaid has advantages over being uninsured, and conservatives do themselves no favors by arguing otherwise.
Nevertheless, liberals’ claims of the massive life-saving power of Medicaid are unsupported. Tens of millions acquired Medicaid and non-Medicaid coverage since 2010, with no visible effect on mortality rates. The data even suggest better mortality results in states that declined the Medicaid expansion. And unfortunately, Medicaid is a hot center for rising opioid deaths. Still, conservatives should be cautious about pouncing on these observations.
One can legitimately oppose the Medicaid expansion out of compassion for potential beneficiaries. In the 1990s, the best of intentions led Tennessee to expand its Medicaid program (TennCare). The result was near-collapse of state’s finances, relieved only when 200,000-plus beneficiaries were kicked out of TennCare. There’s legitimate reason to fear a similar outcome from the ACA’s Medicaid expansion.
There’s also reason to fear that Medicaid’s expansion is shifting care toward new enrollees (childless, often-healthy adults) and away from pre-ACA beneficiaries (children, pregnant women, the elderly, the disabled).
The real question isn’t whether Medicaid brings some value to its enrollees. It’s whether lower-income Americans are better-helped by more Medicaid spending or more spending on other programs. Evidence is powerful that employment, education, environment and community have far greater effect on health than health care. Dollars spent on Medicaid are dollars not spent in these other areas.
Today, it’s the Republicans accused of “killing poor people for rich people’s tax cuts.” But demagoguery metastasizes. This month, some on the left are hurling the same accusations against California Democratic legislators who tabled a single-payer proposal out of fear of bankrupting the state. Some of those legislators have reported receiving death threats.
When we abandon humility and deny our adversaries’ humanity, we uncork a dangerous genie.