Paul Ryan, the speaker of the House, has long had a reputation as the Serious Republican. He is an alleged policy wonk who, whether you agree with his politics or not, is knowledgeable and committed to generating innovative policy proposals. In many quarters, this reputation appears to be intact—the Washington Post’s Chris Cillizza, a reliable barometer of Beltway conventional wisdom, gushed over Ryan’s “very impressive” town hall appearance in January. But Ryan’s reputation has always been a complete fraud. He has consistently offered extreme versions of well-worn Republican proposals to take from the poor and give to the very wealthy. He has not even defended these proposals honestly. And nowhere is the gap between myth and reality more evident than when Ryan tries to defend the GOP’s position on health care.
Despite Ryan’s supposed interest in policy detail, his party’s plans to replace the Affordable Care Act have been farcical. The website set up for the House plan literally consists of one sentence promising outcomes with no detail, and a video promising to come up with an undefined plan at some later date. Ryan’s previous blueprint, as Jonathan Cohn and Jeffrey Young of the Huffington Post put it, was more “37 pages of talking points” than a plan. Ryan’s defense of the Republican not-plans-yet to replace the ACA are embarrassingly specious arguments, when they have any content at all:
Having the freedom to “buy what you want” sounds good! Only in the
context of health care, it’s a disaster for the non-affluent. Many people
cannot afford basic health care services, and the vast majority of people
cannot afford care for an unexpected major illness. Giving rich and poor people
alike the “freedom” to purchase as much health care as they think they need is
a cruel joke, not a serious health care policy. And it’s worse than that;
people cannot, in fact, reliably predict how much health care they might “need”
in the future, which is why insurance is necessary for practical access to
health care in the first place.
Ryan is also attacking the regulations that require insurance—both employer-provided and purchased on exchanges—to meet minimum coverage requirements. But this is not “freedom” of any value. Regulations that protect customers from junk insurance reduce their “freedom” in the sense that FDA regulations take away people’s “freedom” to buy beef laced with strychnine. It’s true that under the ACA young and healthy people pay more for insurance than they would under a “free market” in health care, but this is how insurance works: You pay more now so you can afford insurance later. Objecting to the ACA because the young and healthy pay more than they otherwise would is like saying its unjust to pay taxes to support the fire department when your house hasn’t burned down.
His critiques of the ACA are similarly ridiculous:
The assertions about “massive” premium and deductible increases are extremely misleading. All the evidence suggests that deductibles and premiums for similar insurance policies would be considerably higher without the ACA. It is true that the subsidies and the ACA as a whole should be more generous and some of the available insurance is too expensive. But any Republican plan would lower subsidies and hence make the problem much worse, while also allowing customers to get ripped off by unscrupulous insurers.
Granted, Twitter isn’t the place for nuanced arguments. But given more characters to work with in a statement defending the GOP’s plan to “repeal and replace,” his arguments don’t improve. Consider this passage, responding to House Minority Leader Nancy Pelosi’s accurate claim that Ryan’s repeal would mean ”death, disability, and suffering,” all to “give a massive new tax break to the wealthiest”:
Similar claims of 36,000 annual deaths made by Sen. Bernie Sanders (I-VT) were already disproven earlier this month—but that didn’t stop Leader Pelosi from following suit. Unfortunately, this law has proved its shortcomings on its own.
But if you click the link provided, there was no “debunking” of Pelosi’s claim. Rather, a Washington Post fact-checker disputed the precise figure given by Sanders. This is a remarkably uncharitable reading of Sanders’s assertion. Indeed, the tools of social science do not allow us to know whether the number of people killed under repeal would be exactly 36,000 per year. The fact remains that Pelosi’s claim that Ryan’s repeal would result in large amounts of avoidable death, suffering, and bankruptcy remains indisputably true—Ryan is just quibbling over the exact number.
Furthermore, his argument about the ACA’s “shortcomings” merely repeats his attacks on features of the ACA that aren’t shortcomings (the elimination of junk insurance) and real problems his alternative would make considerably worse (decent insurance being too expensive and hard to find in rural areas and in states determined to sabotage Obamacare).
Admittedly, Ryan’s arguments are terrible largely because Republican health care policy proposals are terrible. Waiting for the House replacement for Obamacare has been like waiting for Godot, and when unveiled it’s sure to be massively unpopular. Ryan has avoided this backlash by being a member of the opposition, but with Republicans in charge of the legislature and the executive he can no longer hide behind his fictitious reputation for wonkery. This reputation stems in part from his alleged willingness to be a brave truth-teller who tells people what they don’t want to hear—and yet he uses feeble buzzwords to completely evade the concrete tradeoffs contained in any conservative alternative to the ACA.
Hopefully Ryan’s predecessor, John Boehner, is correct that his plan to kill the ACA is doomed to fail. But Ryan’s utterly unserious defenses of a very serious attack on the most important social welfare statute passed by Congress in nearly a half-century should finally end his completely unearned reputation as an honest broker with a command of policy detail. If it can survive this, it will be as unkillable as Twinkies and cockroaches.