Paul Ryan and Mitt Romney were battered yesterday on the usually pretty-soft Sunday talk shows. How rough was it? As I worked out at the gym this morning, I watched Donald Trump lambaste NBC’s painfully moderate David Gregory as a virtually paid advocate for President Obama. Across the bottom was the headline: “Do the math.”
Romney and Ryan’s real problem was that they hadn’t done the math themselves, or at least they hadn’t shown their work. James Fallows notes that even reporters at FOX News seem increasingly irritated by the lack of detail, and by the succession of shifting rope-a-dope responses.
The secretiveness and evasion encompassed Medicare, Medicaid, where they would cut popular tax deductions to finance proposed tax cuts on the affluent, where they would cut discretionary spending to meet their own professed budget numbers – pretty much the entire gamut of domestic social policy.
Romney and pre-existing conditions
The most perplexing item concerned whether and how Governor Romney would protect Americans with pre-existing health conditions. This is a very, very popular element of health reform. A recent poll (reported by Greg Sargent here) finds that 78 percent of Republicans support “banning insurance companies from denying coverage for pre-existing conditions, and that 86 percent favor “banning insurance companies from cancelling policies because a person becomes ill.”
Seeking to accommodate this sentiment, Governor Romney stated the following yesterday on Meet the Press:
Of course, there are a number of things that I like in healthcare reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage.
But the same day, Romney aides clarified these comments to the National Review, noting that
Governor Romney will ensure that discrimination against individuals with pre-existing conditions who maintain continuous coverage is prohibited. [emphasis added].
[I]n a competitive environment, the marketplace will make available plans that include coverage for what there is demand for. He was not proposing a federal mandate to require insurance plans to offer those particular features.
As Jonathan Cohn, Steve Benen, Kevin Drum, and Sarah Kliff quickly noted, there is a world of difference between the protections provided by the Affordable Care Act and Governor Romney’s proposals. The words “maintain continuous coverage” elbow aside millions of people. Life being what it is, millions of low-income people have periods of uninsurance and joblessness. People lose jobs and can’t afford their COBRA payments. People take a bad gamble, go uninsured, then have a tragic accident or encounter serious medical trouble.
Right now, about four million Americans are uninsured, and have been previously diagnosed with serious conditions such as cancer, COPD, stroke, or heart attack. This is a far larger number of medically uninsured people than could be feasibly assisted through high-risk pools or other measures Republicans have discussed. Millions more among the uninsured have other conditions that attract unfavorable terms in the individual and small-group insurance market.
People of modest incomes need financial help buying coverage, particularly when they are ill. People need stronger protections against a variety of insurer practices that shift costs onto sick people. People need regulations to ensure that health insurance actually covers reasonable treatments. People need regulations that prohibit annual and lifetime dollar-coverage caps that leave families vulnerable to medical bankruptcy in the event of catastrophic illness. This is the kind of detail that’s spelled out, budgeted, and scored in the Affordable Care Act.
Math fuzzier than ever
The details of Governor Romney’s proposal on these issues don’t appear to go much beyond what’s already in the current HIPAA law. More to the point, the fine print of Romney’s proposal doesn’t’ seem to exist, or it evolves, or it requires constant clarification by some campaign aide as some particular issue heats up. As my colleague Aaron Carroll lamented in the Incidental Economist, “We’re never going to get answers, are we?”
For 30 years, Republicans have been getting away, politically, with providing fuzzy numbers about so many things. The Romney campaign has rather explicitly decided that it’s better to offer vague bromides about the virtues of limited government than it is to get down to the specifics in proposing unpopular measures required to make their proposals work.
I believe that four strategic considerations undergirded this approach. They should be blamed for two of these. The third and fourth are really the fault of the American public and the news media.
The first consideration is simple. Their numbers don’t add up. Independent experts find that a revenue-neutral version of the Romney/Ryan tax plan would require significant tax increases on most Americans. Representative Ryan’s proposed budgets include many implausible features, not least of which are historically unprecedented and politically infeasible reductions in the discretionary components of American government.
Moreover, the fine print of Republican proposals – such as this fine print exists – would be very unpopular. MSNBC host Joe Scarborough tweeted, “The Romney campaign is not conservative…. A real conservative would be winning now.” Actually, the opposite is true. A “real conservative” would get clobbered, once his platform were widely understood. Most Americans reject proposals to convert Medicare to a defined-contribution framework. Most Americans reject further tax cuts that primarily benefit the most affluent members of our society. With the exception of the individual mandate, most Americans favor the main pillars of health reform, too.
Third – and this is not entirely Republicans’ fault – we live in a gotcha political and media culture in which it’s virtually impossible to frankly discuss complex policy proposals. Republicans know better than anyone that a well-articulated policy proposal in health care or taxes includes icky items such as reduced subsidies to favored or entrenched constituencies, or something complex that can be easily mischaracterized as a death panel.
The fourth consideration is really the flipside of the third. There is too little reward for actual policy substance, and there’s too little demand for the fine print concerning critical matters that affect tens of millions of people. Republicans propose trillion-dollar changes to our taxation and social insurance systems – changes that go well beyond repealing and replacing President Obama’s health reform. Up to this point, anyway, they have refused to provide the details required for truly independent scrutiny. And they had good reason to believe that they would get away with this.
Somehow, President Clinton’s masterful convention speech has changed this political dynamic. It’s about time.
Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has written about health policy for the Washington Post, New York Times, New Republic, The Huffington Post and many other publications. His essay, “Lessons from an Emergency Room Nightmare,” was selected for The Best American Medical Writing, 2009.