NEW YORK — There are three kinds of lies: lies, damned lies and Republican claims about health care.
OK, it’s not news that politicians make misleading claims, some more than others. According to a running tally kept by Daniel Dale of The Toronto Star, as of Monday morning, Donald Trump had said 4,682 false things as president.
But GOP health care claims are special, in several ways. First, they’re outright, clearly intentional lies — not dubious assertions or misstatements that could be attributed to ignorance or misunderstanding. Second, they’re repetitive: Rather than making a wide variety of false claims, Republicans keep telling the same few lies, over and over. Third, they keep doing this even though the public long ago stopped believing anything they say on the subject.
This syndrome demands an explanation, and I’ll get there eventually. Before I do, however, let’s document the things that make GOP health care lies unique.
First, as I said, I’m not talking about mere dubious claims. When Trump officials insisted that the 2017 tax cut would lead to a decade of miraculous growth, their claim made no sense in terms of the underlying economics, and it flew in the face of decades of evidence. But it was a prediction, not a statement of fact, and it’s conceivable (barely) that Trump’s people actually believed it.
But when Mick Mulvaney, the acting White House chief of staff, went on TV Sunday to declare that “every single plan” Trump has put forward “covered pre-existing conditions,” that was just a lie.
Here’s what the Congressional Budget Office said in its assessment of the Republicans’ American Health Care Act, which would have caused 23 million to lose coverage, and would have passed if John McCain hadn’t voted “No”: “People who are less healthy (including those with pre-existing or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”
But Mulvaney’s pre-existing conditions lie, along with his lie about nobody losing coverage if the lawsuit against Obamacare succeeds, was normal by GOP standards. Which brings me to the second reason this particular form of lying is exceptional: Republicans just keep telling the same lies, over and over. Again and again they have promised to maintain coverage and protect pre-existing conditions — then offered plans that would cause tens of millions to lose health insurance, with the worst impact on those already suffering from health problems.
The funny thing — which is my third point — is that almost nobody seems to believe these lies. On the eve of last year’s midterm elections, the public trusted Democrats over Republicans to protect Americans with pre-existing conditions by 58 percent to 26 percent. A margin this big tells us that even Trump supporters knew their man was lying on this issue.
So what’s behind the persistence of RHLS — Republican health care lying syndrome?
Well, public opinion here is clear: Americans want everyone to have access to health care. There isn’t even that much of a partisan divide: An overwhelming majority of Republicans don’t believe insurance companies should be allowed to deny coverage or charge more to those with pre-existing conditions.
This public near-unanimity is one reason Medicare is so popular. Getting older — and thus joining a group with much higher average health costs than the rest of the population — is, after all, the ultimate pre-existing condition.
But there are only two ways to cover people with pre-existing conditions, and both are anathema to conservative ideology.
One is to have taxpayers pay the bills directly, which is what Medicare does.
The other combines regulation and subsidies. Insurance companies must be prohibited from discriminating based on medical history — a prohibition that must include preventing them from issuing bare-bones policies that will appeal only to those in good health — but that won’t do the job by itself. Healthy people must also be induced to sign up, to provide a good risk pool, which means subsidizing premiums for those with lower incomes and, preferably although not totally necessary, imposing a penalty on those without insurance.
If the second option sounds familiar, it should. It’s what countries like the Netherlands and Switzerland do; it’s also a description of, you guessed it, Obamacare.
But Republicans cannot admit that the only way to protect pre-existing conditions is to emulate Democratic policies. The party of Eisenhower, or even the party of Nixon, might have been able to do such a thing, but the party of Fox News cannot.
Nor, however, do Republicans dare admit that they have no interest in providing protection that a vast majority of voters demands. So they just keep lying.
You may, by the way, have heard talk about GOP members of Congress opposed to Trump’s new health care push. But they share his goals; they’re just questioning his timing. The whole party still wants to take away your health care. It just hopes to get through the next election before you find out.
Paul Krugman is a syndicated columnist who writes for the New York Times News Service.
