As the Republican Party struggled and then failed to repeal and replace Obamacare, pulling a wildly unpopular bill from the House without even taking a vote, a flurry of insightful articles helped the public understand what exactly just happened. Robert Draper explained the roles that Stephen Bannon, Paul Ryan, and others played in deciding what agenda items President Trump would pursue in what order. Politico reported on how and why the House Freedom Caucus insisted that the health care bill repeal even relatively popular parts of Obamacare. Lest anyone pin blame for the GOP’s failure on that faction, Reihan Salam argued persuasively that responsibility rests with poor leadership by House Speaker Paul Ryan and a GOP coalition with “policy goals that simply can’t be achieved.”
But dogged, behind-the-scenes reporting and sharp analysis of fissures among policy elites do not capture another important contributor to last week’s failure—one Josh Barro came closest to unpacking in a column titled, “Republicans lied about healthcare for years, and they're about to get the punishment they deserve.”
The article isn’t an attack on conservatives and libertarians.
Plenty of plausible alternatives to Obamacare have been set forth by people who are truthful about the tradeoffs involved. For instance, The Atlantic published a plan in 2009; Ezra Klein and Avik Roy usefully illuminated the disagreements between serious conservative and progressive health-care wonks; and Ross Douthat suggested reforms that borrow heavily from Singapore. Barro is aware of many smart right-leaning critiques of Obamacare and sympathetic to some.
What he points out in his column is that the GOP didn’t honestly acknowledge the hard tradeoffs inherent in health-care policy before making the case for a market-driven system.
Republicans tried to hide the fact of tradeoffs:
For years, Republicans promised lower premiums, lower deductibles, lower co-payments, lower taxes, lower government expenditure, more choice, the restoration of the $700 billion that President Barack Obama heartlessly cut out of Medicare because he hated old people, and (in the particular case of the Republican who recently became president) "insurance for everybody" that is "much less expensive and much better" than what they have today. They were lying. Over and over, Republicans lied to the American public about healthcare. It was impossible to do all of the things they were promising together, and they knew it.
That is basically correct. And it helps explain how Republicans could win a presidential election and lots of congressional elections on the promise of repealing and replacing Obamacare, only to produce a bill that was wildly unappealing to voters.
Once Republicans commenced governing, the tradeoffs couldn’t be elided any longer.
Still, even the insight that Republicans spent years willfully obscuring the tradeoffs involved in health-care policy doesn’t fully explain the last week. Focusing on GOP officials leaves out yet another important actor in this debacle: the right-wing media. By that, I do not mean every right-leaning writer or publication. Over the last eight years, lots of responsibly written critiques of Obamacare have been published in numerous publications, and folks reading the aforementioned wonks, or Peter Suderman at Reason, or Yuval Levin, or Megan McArdle at Bloomberg, stayed reasonably grounded in the actual shortcomings of Obamacare.
In contrast, Fox News viewers who watched entertainers like Glenn Beck, talk-radio listeners who tuned into hosts like Rush Limbaugh, and consumers of web journalism who turned to sites like Breitbart weren’t merely misled about health-care tradeoffs.
They were told a bunch of crazy nonsense.
As I was drafting this article, Ted Koppel made headlines by telling Fox News entertainer Sean Hannity that he is bad for America. This upset some conservatives, who felt it was just another instance of the mainstream media attacking a fellow conservative. I don’t think that conservatives are typically bad for America. But I lament the fact that Hannity is still employed in my industry, in large part because his coverage of subjects like Obamacare is dishonest—and I say that as someone who has preferred a very different health-care policy since 2009.
Back then, my maternal grandmother was still alive, and I remember her listening to Hannity on Fox and getting very angry, upset, and afraid about what would happen next. I do not exaggerate when I say that the Obamacare debate lowered the quality of her last years. But not because she was so opposed to the actual tradeoffs that Obama and the Democrats were proposing that it made her anxious.
She was upset because Hannity said scary things like this:
So it sounds to me like they're actually encouraging seniors in the end, "Well, you may just want to consider packing it all in here. This is—" What other way is there to describe this? So they don't become a financial burden on the Obamacare system? I mean, that's how they intend to cut costs, by cutting down on the amount of health care that we can give and get at the end of our lives and dramatically cutting it down for senior citizens? You know, welcome to the brave new world of Obamacare. We're going to encourage, you know, inconvenient people to consider “alternatives to living.” Well, that just sounds terrific, which by the way is not uncommon and has been a source of deep concern in places like Great Britain. You know, the place where they have a government rationing body that denies women with advanced breast cancer their health care.
She mistook Hannity for a man with integrity, who would never go on national television or nationally syndicated radio and willfully or carelessly mislead millions.
That was a mistake. Had Hannity been an outlier in this respect, perhaps people like me could have persuaded people like my grandma that whatever the demerits of Obamacare, the bill would not cause a bureaucrat to send Dr. Kevorkian to her bedside, or render her grandchildren servile subjects in a totalitarian dystopia.
Instead, Sarah Palin posted this to her Facebook page:
The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care.
Such a system is downright evil.
Chris Baker said this on Glenn Beck’s radio program:
Sir, you're overweight. What? Yes, sir, you are overweight, we're going to have to require you to lose weight. And if you don't lose weight on your own, we're going to send you to a fat camp and make you lose the weight. And if you still don't lose the weight, then you know, we're just going to have to do surg—we're just going to have to put you in jail. And if you don't lose the weight in jail, sir, I don't know what else to do. Maybe some end-of-life counseling might be good. I mean, I remember a woman that got—that was greased by Dr. Kevorkian because she was fat.
Beck himself warned: “This is the end of prosperity in America forever if this bill passes. This is the end of America as you know it."
Said Rush Limbaugh, “When this passes, they will have even more power, regulating every aspect of our lives, because they believe in their minds and hearts that we have no competence whatsoever to lead our own lives and make our own decisions."
On another occasion Limbaugh added:
It's not going to be a matter of whether you can or cannot pay. It won't be a matter of whether you have coverage or don't have coverage. What'll matter is that all of us will be slaves; we'll become slaves to the arbitrary and inhumane decisions of distant bureaucrats working in Washington where there's no competition, nobody you can go to if you don't like what you hear from the bureaucrats that you have to deal with."
Said Jim Quinn:
Ladies and gentlemen, you have to understand that we are at a critical and pivotal moment in the history of the United States. If they pass health care, government health care, that is the end of the republic. That is the final nail in the coffin of the individual free human being. Once they own your body, they own everything. Once they can withhold health care from you, because you're too old, because you're too sick, or maybe 'cause they just don't like you -- did you ever think about that?
These aren’t just egregious, scare-mongering falsehoods that a few people uttered on a few occasions. They represent the tenor of coverage on right-wing TV and radio across scores of hours of broadcasting. This is the largely forgotten context that helps explain why my colleague David Frum could not have possibly succeeded in persuading elites on the right to work with Democrats to improve Obamacare (rather than guarantee that it would pass without any Republican input).
The coverage offered by right-wing media in those years also helps explain why elected Republicans never developed compelling arguments for why voters should prefer a different set of tradeoffs.
Right from the start, commentators who long ago traded their integrity for ratings spewed falsehoods so wild that anyone on the right could justify outright opposition to the legislation, without having to explain anything. “The Slaughterhouse Three, Obama, Pelosi and Reid, have authored the legislation that will make every American a POW, strip them of their Freedoms and Liberty and shove them in a meat cellar for cold storage,” a commentator at Breitbart declared in 2010. “So how is that Hope and Change working for you now?”
To take these people at their word was to assume merely repealing Obamacare would leave everyone better off. (Whose lot wouldn’t be improved by avoiding POW status?) Of course, Obamacare passed, and Americans were subject to neither cold storage nor death panels nor the end of individual freedom nor the abolition of all private insurance. Down syndrome kids were just fine. Millions gained coverage.
The right-wing entertainers never corrected bygone falsehoods or erroneous predictions when their fabricated catastrophes failed to unfold. They just shifted to new falsehoods. They are too numerous to detail, so let’s stick with a few more examples from Hannity. Here he is demagoguing a little girl’s lung transplant. Eric Stern re-reported a 2013 Hannity segment on specific Americans allegedly harmed by Obamacare to illustrate how egregiously the show misled viewers. The same year, Politifact explained why Hannity was wrong to make the outlandish claim that Obamacare would cause fully half of Americans to lose health insurance.
The point isn’t that Obamacare was without flaws, or that no one was pointing them out, but that many of the most-watched conservative entertainers were spreading wild falsehoods rather than cogently explaining the bill’s real costs and shortcomings. There were defensible reasons to oppose the law, but many who told pollsters they were against Obamacare had indefensible reasons, in that they were grounded in the wild falsehoods. What’s more, on a cable-news network that bills itself as “fair and balanced,” viewers were seldom given any information about Obamacare’s benefits or exposed to any stories of folks who were helped by it.
At more responsible right-leaning outlets, the right-wing audience still wouldn’t encounter direct refutations of Hannity or Beck, because most right-leaning journalism outlets pull their punches when it comes to Fox News and its personalities. They want their writers to be invited on the network; journalists who write books want to publicize them there; and they certainly don’t want to anger their core readers by criticizing popular talk-radio hosts.
In the long run, mendacious right-wing health-care coverage had consequences. A significant faction of conservatives felt Obamacare was so dumb and malign that repeal alone would be a tremendous boon to all Americans, imposing significant costs on almost no one.
As Peter Suderman wrote:
Trump spent the last two weeks selling the House plan. He met with specific individuals and with various congressional factions opposed to the bill. He personally called the offices of more than 100 legislators. He has cajoled and threatened, telling those who refused to back the legislation that they would lose their seats. He threw the entire weight of his personality and the office of the president behind the vote, saying that he backed the bill "one-thousand percent." But he never took the time to explain to either the public or congressional Republicans what the bill actually did.
He did not make a case for the bill's policy merits, preferring instead to describe it using generic superlatives. Contrast that with President Obama, who traveled the country making the case for his health care overhaul, and made a major prime time address outlining its provisions. Trump, in contrast, was, by virtually all accounts, indifferent to the policy content of the bill so long as it passed and he could say that he had fulfilled his promise to repeal and replace Obamacare.
The Republican Party had previously benefited politically from its indifference to substance on health-care reform.
In the end, however, less than 20 percent of U.S. voters favored the passage of the Obamacare repeal bill, because even large swaths of the Republican base eventually discovered that, contrary to everything they’d been led to expect, repeal imposed huge tradeoffs!
There are many who people bear responsibility for the GOP’s failure to improve upon Obamacare. But when apportioning blame, the right-wing media should not be forgotten.