When lawmakers and pundits debate policy, they are invariably talking about people’s lives. Every policy enacted by the federal government has an impact, large and small, for better or worse, on citizens and their quality of life, and entails some cost. These decisions are far from easy, and in certain areas of policy—war or health care or the environment—they can be life-and-death decisions. The duty of the lawmaker in these instances is to wrestle with the ultimate cost, and judge whether it is worth a policy that presumably will save or make better even more lives. This is how lawmaking works in a big country with many competing interests.
But in the debate over the Senate’s health care bill, Republicans and their allies have sought to shut down this fundamental aspect of the policy debate. This approach has since crept into the way the media is approaching the issue, as if it is an abstract affair—a game—with no real-world consequences for voters. Worse, it has been suggested that the very insistence on considering these consequences is an example of blind partisanship.
The Republican leadership in the Senate has literally shut down debate on the bill, but its conservative allies in the world of health care policy have tried to muzzle it in other ways. This was perfectly encapsulated in a tweet by Avik Roy, president of the Foundation for Research on Equal Opportunity, a very official-sounding think tank that popped up in 2016 seemingly just to orchestrate a repeal of the Affordable Care Act. (When asked whether he advised the GOP on its health care bill, Roy declined to clarify.)
Roy is suggesting that the claim that people will die is either false or unserious. On the former point, Roy has been joined by the sociologist Charles Murray, who seemed to argue that it is impossible to make empirical life-or-death claims about policy.
But of course people will die under the Republican health care bill. The CBO score for the Senate’s Better Care Reconciliation Act shows that 22 million people will be kicked off their insurance over the next 10 years, 15 million starting next year. Premiums for older people would skyrocket and become unaffordable for many people. And when people lose health insurance, their health suffers, which, inevitably, leads to some deaths. (Contra Murray, there are also ways to measure whether policy has saved lives.)
The conservative estimate, based on a recent paper published by Harvard researchers in the New England Journal of Medicine, is that one life is saved for every 830 adults who gain health insurance. That means passing the BHRA would directly kill about 200,000 people over the next decade. That’s not “millions” of preventable deaths, but it is still a lot of preventable deaths. And even if the number is lower, these are preventable deaths that at least need to be discussed. (Of course, this is not even to mention the many ways in which the Senate’s health care bill will simply make people’s lives worse.)
Roy also appears to be claiming that such nakedly emotional appeals are not helpful—that policy-makers and pundits should make a stoic, dry-eyed case for whether a policy is good for society as a whole. But what’s extraordinary about the debate surrounding the GOP’s health care bill is that Republicans are not trying to make this argument. They are not saying that depriving millions of people of health insurance will result in better care for everyone, in the aggregate. They are simply lying about what is contained in the bill, as my colleague Jeet Heer pointed out this morning. This is because there is no policy argument for what Republicans are doing, other than a dogmatic belief that taxes and the social safety net are bad.
This has somehow been lost on certain pundits in the mainstream media. On Monday night, CNN’s Chris Cillizza revealed a fun new feature—an emoji-meter that tells readers what he thinks the chances of passage are for the Senate’s health care bill. Here is the handy key, as written out by Cillizza: “There are three options: 1) Smiley face (good chance of passage) 2) Meh face (50-50-ish chance) and 3) Sad face (less than 50% chance). Every day I’ll write a post with an emoji update of the bill’s chances.”
As Ben Dreyfuss, an editor at Mother Jones, pointed out on Twitter, this means that 22 million people who are on the brink of losing their health insurance are going to be praying they won’t see a nightmare-ish yellow smiley face staring back at them.
The backwardness of Cillizza’s key is easy to mock. But it’s indicative of an endemic problem among the pundit class: a complete divorce from the policy itself. Only someone who will not be affected by the GOP’s push to repeal and replace Obamacare would attach a smiley face to the bill’s passage without some serious second thoughts. The fact is that the people who crafted this bill and who are commenting on it are mostly distanced from its effects. If anything, they are more likely to benefit from the bill’s enormous tax cuts for the wealthy.
In defense of his smile-for-death chart, Cillizza argued that claiming the Senate bill will kill people “seems like a pretty big partisan assumption.”
And there we reach apotheosis, in which even the debate about policy gets thrown into the hyper-polarized matrix of partisan politics—which is exactly what the Republican Party wants.
Policy has adverse consequences. If we send people to war, people will die. If we consign people to live in poverty, people will die. If we take away health insurance, people will die. It has become increasingly harder for the GOP to justify these deaths with anything remotely resembling sensible policy, so now it seeks to take them out of the equation altogether.