The discussion will be about everything but the things the discussion is actually about.
As the Senate shambles toward consideration of the American Health Care Act and the fate of Obamacare, Democrats and the news media are preparing a wall of noise to prevent real debate. The fight in the House showed the pattern: The left plans to discuss their own landmark health care law by not discussing it at all. Instead, the public conversation over health care reform will center on a series of chimeras and strawmen, in a great and persistent changing of the subject.
Two pieces of rhetorical legerdemain will be particularly important.
First, Democrats will say that Obamacare “gave” health care to twenty million Americans. Left unsaid is the central reality of a coercive and punitive law: More Americans have health insurance now than in 2008 because Democrats adopted a law that requires people to buy it, and punishes them with IRS-imposed fines if they don’t.
A man comes to you, groaning and holding his stomach. “I’m so hungry,” he tells you. He has a few dollars to his name, but he’s saving that money to pay the electric bill, and he doesn’t have anything left over for food. You respond by ordering him to buy a sandwich, and threatening to punch him in the face if he doesn’t. So he does. He gives in to your threat, buys a sandwich with his own money, fixes his hunger, and can’t keep the lights on in his house.
“See?” you tell him, “you were hungry, and I gave you food.” Weirdly, he doesn’t thank you.
As the Senate discusses Obamacare, Americans can’t lose sight of this central fact: A debate over the future of this law is a debate over a policy of coercion. The Affordable Care Act is, first and foremost, punitive. Its purpose is to threaten and punish. To partially repeal and restructure Obamacare, as the House has voted to do, is to attempt to reduce the infliction of deliberate and calculated punishment on the American people.
Second, Democrats will say, as they said during the debate in the House, that Republicans are trying to “take health care away” from Americans. What they won’t mention is that Obamacare was carefully designed to, wait for it, take health care away from Americans.
One of the central features of Obamacare is the “Cadillac tax,” a federal levy on health insurance plans that the government deems to be excessive. That is, if the government thinks you have too much health insurance coverage, making it possible for you to use a lot of health care without being subjected to personal costs that are high enough to hurt, then you (or your employer, if you have employer-provided health insurance) have to pay a heavy tax on your insurance plan.
Again, the point is behavior-changing punishment: The government wants to disincentivize the overconsumption of health care. Making your good health insurance painfully expensive, they want you or your employer to drop it – and get a plan that gives you less coverage, with higher deductibles and more severe out-of-pocket costs. Since health care becomes more expensive for you, you consume less of it. The federal government has very deliberately taken away some of your health care.
This deliberate disincentivization of overconsumption is Obamacare, the very heart of the law and the policy it shapes. This is a good time to remind everyone you know that one of the principal architects of the law, Ezekiel Emanuel – a professor of healthcare policy at the University of Pennsylvania, and the brother of the White House chief of staff at the moment Obamacare was signed into law – has argued that Americans should die younger, refusing to consume health care as they age:
“This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age… After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery.”
Hilariously, Emanuel describes all of this as his personal choice rather than an argument he intends as a policy prescription. That’s why he published it in a national magazine. Make no mistake: Democrats want you to die younger, so you consume fewer resources. That’s how the Affordable Care Act is intended to make health care more affordable: It’s designed to make sure affluent and older people get less of it, and it was designed that way by people who want you to stop burdening society with the cost of your medical treatment. The most affordable health care is no health care at all.
Note the extraordinary chutzpah of the rhetorical maneuver in which people who designed a law with the specific intent of taking health care away from people warn that the opponents of their law are motivated by a desire to take health care away from people. It’s an example of a core practice of the social justice warrior, DARVO: Deny, attack, reverse victim and offender. You want to overturn my law that takes health care away from people because you want to take health care away from people. The shamelessness is palpable.
Americans have to be clear about what Obamacare is and what it does. Over the next few months – and not for the first time – a lot of people will be working very hard to prevent that clarity.
Chris Bray is the author of Court-Martial: How Military Justice Has Shaped America From the Revolution to 9/11 and Beyond, released last year by W.W. Norton.