Friday, March 17, 2017

Kasich Op-Ed on Health Care: The Annotated Version

by Neil H. Buchanan

Recently, The New York Times published a guest op-ed written by Ohio Governor John Kasich.  Kasich, a Republican, insists that he wants everyone to be moderate and bipartisan, especially regarding health care.

Some readers, especially those who have not yet hit their fortieth birthdays, might only know Kasich as the failed presidential candidate who managed to be among the last three men standing in last year's Republican primaries.  Other readers might simply have forgotten most of the key details of Kasich's long political career.

With that in mind, I am happy to provide here a translation of some of the key selections from Kasich's op-ed.  Think of it as Kasich under the influence of truth serum.


[Text]
John Kasich: End the Partisan Warfare on Health Care
By John Kasich, March 10, 2017

[Translation]
Hi, I'm John Kasich.  I was a member of Congress from Ohio for eighteen years, during which time my party made a lot of noise about how members of Congress should be term-limited to much less than eighteen years.  I became one of Speaker Newt Gingrich's top lieutenants in his successful efforts to end inter-party cooperation in the 1990's.  I voted to impeach President Bill Clinton.

Now, I am presenting myself as a moderate, and to my amazement, it seems to be working.  Even the editorial board of The New York Times all but endorsed me in the Republican presidential primaries last year, notwithstanding my extreme views on abortion, immigration, mitigating climate change, and nearly every other issue that matters.  Next to Ted Cruz, I looked less scary.  Lucky me!

[Text]
Americans are relying on leaders in Washington to fix health care, not engage in yet another unproductive partisan standoff. In 2010, one side of the political aisle in Congress, the Democrats, chose to “fix” health care unilaterally, without bipartisan support. The result was Obamacare, which has run up government spending while failing to drive down the cost of health care.

Now, with the political tables turned in Washington, the Republicans are starting down the same unilateral path, a course that can only further divide the nation. A true and lasting reform of the health insurance system must be accomplished by bringing the two sides together, not by replacing one divisive wedge with another.

[Translation]
I certainly know a lot about divisive wedges, and one of the best moves that people like me have developed over the years is to raise the level of vitriol and then complain that the conversation has become so unpleasant.  As but one small example, even as I posture about being nonpartisan, I make sure that I use the non-word "Obamacare" instead of Affordable Care Act.

Here, I am repeating the well worn lie that the 2010 negotiations over the health care bill were one-sided and that the Democrats refused to reach out to Republicans.  This is, as another op-ed for this newspaper put it, "The Original Lie About Obamacare."  The truth is that my Republican cohorts were told to oppose anything that Obama proposed, for purely political advantage.  Mitch McConnell, then the Senate Minority Leader, told his party's members to deny Obama any votes so that the president could not claim that the bill was bipartisan.

Having dishonestly characterized what the Democrats did in 2010, I now try to sound high-minded by saying that the Republicans should be bipartisan to show that they are better than Democrats.  But why should Republicans, who have the numbers to pass whatever they want, care about bipartisanship?  Because we will want to pass the buck when this thing goes bad, of course.  But I cannot say that out loud, so I will wrap myself in the warm glow of reasonable bilateralism.

The fact is that "true and lasting reform of the health insurance system" could be accomplished by one party.  If the Republicans really have a plan that would make people better off, they can pass it without Democratic votes and then let the people defend the law against future assaults.  But wait, that is what is actually happening with the ACA.

That law has not turned out to be perfect, but it has made people's lives much better, and a majority of the country now supports the law.  For that matter, there is a lot of support for a "Medicare for All" single-payer system, but I am not going to say that such a popular and less expensive plan should be adopted, because I am committed against all evidence to the idea that the ACA is a failure and that "market reforms" are the answer to every problem.  It is too inconvenient to note that the ACA is what a market-based health care system has to look like.

[Text]
"Throughout my career, I’ve learned that meaningful change happens only with bipartisan support. When I was chairman of the House Budget Committee in the 1990s, we were able to make over Pentagon spending, revamp welfare and balance the federal budget for the first time in decades because Democrats and Republicans made a commitment to work together. We disagreed and debated, but in the end we agreed to changes that strengthened our country."

[Translation]
I was the chairman of the House Budget Committee when Bill Clinton decided to triangulate on issues like welfare and the budget.  The federal budget was briefly balanced late in his term (as we were impeaching him), but that was to a significant degree caused by a surge of tax revenues during the dot-com bubble.

We got Clinton to agree to "revamp welfare" such that the harms of the bill would not be obvious until we experienced an economic downturn.  And when the Great Recession came, boy oh boy, did people suffer.  My party's response?  Cut off unemployment benefits even as the unemployment rate stayed elevated for years.

But the most important thing to remember about the 1990's is that Gingrich and I were the original post-truth hucksters.  Before he became a U.S. Senator, Al Franken and I got into an argument after a political event.  Newt had given his usual speech in which he bashed the press and Democrats for failing to understand that our Medicare plan would increase benefits from $4800 to $6700 over the space of several years.  Dumb liberals!

Franken, however, tried to get me to admit that these numbers were not adjusted for inflation.  He later recounted in one of his books that he succeeded in getting me to admit that we were being intellectually dishonest.  (The incident is described here.)  Not that I gave up easily, because it was really important to pretend -- even to Franken and a couple of journalists after hours -- that we were not lying.  But it did not really matter, because we just kept on lying about this even after Al got me to fess up.

So yes, Republicans and Democrats "disagreed and debated" in the 1990's, and I was one of the people who was polluting the debate with dishonest nonsense.  But now I am holding up those halcyon days of bipartisanship as an example for all to behold: Let us, as we did in the 1990's, agree across the aisle to figure out more ways to harm the most vulnerable people in the United States.

[Text]
"A responsible, and necessary, repeal and replacement of Obamacare must balance cost and coverage. ...  I have always opposed Obamacare and consistently called for it to be replaced with more conservative, market-driven reforms that actually control health care costs.  ...  But if both sides work together, we can fix Obamacare in a way that preserves coverage, stabilizes the market, reforms Medicaid and controls costs."

[Translation]
So which is it?  Am I in favor of repealing the ACA or "working together" to fix it?  I say that repeal is "responsible, and necessary," but I want to have it both ways, because I want to remain politically viable among Republicans (I'm term-limited in Ohio), but I also want to sound reasonable, too.  So I will say (as I have been saying for years) that we should get rid of the ACA entirely, but I will then say that we should adopt something that does what the ACA does.  If I sound like Donald Trump, please don't tell anyone.

Should I admit that I am unaware that health care inflation has moderated significantly for years, and that the ACA has not changed that?  Should I say out loud that the system has worked better even than its advocates had hoped, given the opposition to it in most Republican states?  No, I will say that the system's current problems are proof that we must throw out the system and adopt something new.

[Text]
"Republican legislation now moving swiftly through the House takes steps in that direction. But the legislation also phases out the expanded Medicaid coverage that is in place in Ohio and 30 other states. Not having a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug-addicted, mentally ill and working poor who now have access to a dependable source of care. ...

"Today we’re providing better coordinated care, Ohio’s Medicaid program is financially stable and per-member spending has been flat for over six years. We’ve been able to extend health care coverage to about 1 million Ohioans, more than 700,000 of them low-income adults.."

[Translation]
This is me in my "Aren't I a nice guy?!" mode.  I was one of the only Republican governors who did not reject the Medicaid expansion for my state, which made me look good in what is still a battleground state.  Now, I am taking credit for the increase in coverage of poor people in Ohio even as I support repeal of the law that caused the improvement, and even as I tell Democrats that they must agree to negotiate with people who are absolutely committed to cutting Medicaid.

[Text]"In my state, we believe that a job is the best anti-poverty program, so we are working to help neighbors who need a hand move up the economic ladder and get the skills and training they need. As we seek to do this, however, we can’t pull the ladder out from under them by taking away their health care."
 
[Translation]
I have now run out of anything even plausibly interesting to say, so I am filling space by saying things that no person could possibly disagree with.  Yeah, take that, all you people in not-Ohio states who don't think that a job is the best anti-poverty program!  As politicians do, I am now speaking in vague terms about the how we are "working" to make things better, not mentioning how much Republicans hate spending on all things, job training included.

I don't know, maybe I really do think it's a bad idea to take away people's health care when they are struggling.  Unlike the people who think that the poor deserve their lot in life, I am at least willing to think that they are victims of circumstance.  Yet I am not really willing to point out that only one side of the political aisle in Washington actually favors policies that would help them, or that the other side of the aisle will never agree to what I am saying here.

And now, I am going to go back to thinking about how to start a constitutional convention to pass a Balanced Budget Amendment, an idea so absurd that even conservative demigod Antonin Scalia ridiculed it.  I guess I'm just confused, but at least everyone knows that I would have been a huge improvement over the guy who beat me in every primary and caucus in 2016.  Except one.  Way to go Ohio!