Few things anger or frustrate me more than somebody who will look you in the eye, smile disarmingly and then tell you an outrageous lie that he expects you to believe. It's not just the lying that gets me; it's the fundamental disrespect for the intelligence of his or her audience.
In that light, the performance by Health and Human Services Secretary Tom Price on a CNN town hall last night went badly from the very beginning and never improved. The first question asked from the audience came from a man named Brian Kline, who last year was diagnosed with Stage 3 colon cancer, was able to get treatment because Pennsylvania had expanded its Medicaid program, and is now cancer-free:
"Medicaid expansion saved my life, and saved me from medical bankruptcy," Kline told Price. "I earn $11.60 an hour at my retail job, so obviously I can't afford to pay for my cancer care out of my pocket.... My question to you, Secretary Price, is pretty straightforward: Why do you want to take away my Medicaid expansion?"
"The fact of the matter is that we don't," Price responded, which is a lie. "We don't want to take care away from anybody. What we want to make certain, though, is that every single American has access to the kind of coverage and care that they want for themselves."
(Somebody making $23,200 a year, as Kline does, has no chance whatsoever of getting "the kind of coverage and care that they want" without financial assistance. But continue, Secretary Price.)
"If you look at the Medicaid program right now, we have one-third of the physicians in this country, Brian, who are not seeing Medicaid patients. So if we want to be honest with ourselves as a society, it's important that we step back and ask ourselves, why is that? Why are those doctors not seeing Medicaid patients? Let me just suggest that it's because the Medicaid program itself has real problems."
Many Americans watching that exchange might believe that Price is genuinely perplexed that more than 30 percent of physicians in this country refuse to see Medicaid patients, a fact that makes it difficult for those patients to find doctors. They might also believe that Price honestly wants to correct those problems, whatever they are. Certainly, he intended to give that impression.
Yet neither is remotely true.
1.) We already know the primary reason that so many doctors either refuse to see Medicaid patients or limit the number they treat: Medicaid pays them so little. It is a particular problem here in Georgia, where Price practiced for 20 years, because Georgia has some of the lowest Medicaid reimbursement rates in the country.
According to a factsheet published last year by the Georgia chapter of the American Academy of Pediatrics, "On average, the Georgia Medicaid program currently pays only about 65 percent of what Medicare pays for the same service and only about 50 percent of what regular commercial insurance pays."
The GCAAP factsheet provides five examples of that payment differential that it describes as typical:
So it ain't brain surgery, or even orthopedics. If you were a doctor with a busy practice, forced to decide which new patient to accept, would you choose the Medicaid patient or the patient with private insurance that will pay you twice as much?
2.) In his response to Kline, Price strongly implies that the "Medicaid reform" plan that he's touting would somehow address the problem of physicians who refuse to take Medicaid. In a perverse way, it's true. It addresses the problem by making it much, much worse. The GOP bill would slash federal funding for state Medicaid programs by $880 billion over the next decade, giving states little choice but to push patients such as Kline off the program and to also further restrict Medicaid reimbursement rates. In short, the plan to "reform Medicaid" is to reform it right out of existence.
Over the hour-long town hall, Price continued to evade and deceive. For example, he repeatedly condemned Obamacare for still leaving 20 million Americans without insurance, and repeatedly claimed that the goal of the GOP plan "is to make sure that every single American has coverage." Yet he offered no explanation of the magic by which that might happen, given the CBO's conclusion that his plan would leave 54 million uninsured by 2026.
However, my favorite moment of the night came when Dana Bash of CNN asked Price about a controversial provision in the bill giving a tax break to health-insurance companies that pay their executives more than $500,000 a year. In a White House press briefing more than a week ago, Price had been asked that same question but had successfully ducked it, claiming "I'm not aware of that; I'll look into that."
This time, Bash was prepared.
Watch that again. Watch how Price tries to feign ignorance, but when caught shifts suddenly, with not a hint of shame, into a detailed, emphatic defense of a provision that a millisecond earlier he had tried to deny altogether.
This is not a man operating in good faith; this is a huckster, and a poor one at that.