More evidence health care reform is mostly safe from being repealed, from Andrew Leonard:

The best bet that Republicans have for derailing healthcare reform isn’t today’s vote, but rather their long-term plan to deny funding for implementation. And yet it’s hard to see how such a strategy would end up creating anything besides an ongoing atmosphere of chaos and uncertainty that would make it very difficult for the insurance industry to operate. There is going to be heavy pressure, behind the scenes, on Republicans not to rock the boat now that the insurers have figured out how they are going to make money.

And they will make money. More Americans with private health insurance means more profits for healthcare insurers, and it also means more consumption of healthcare services. Which leads us directly to the third leg of this triumvirate. As Steve Benen, blogging at the Washington Monthly, points out, nearly one-fifth of the 1.1 million jobs created since the passage of the ACA have been in the healthcare sector. It has consistently been one of the best-performing sectors of the economy. It’s hard to see how adding another 30 million Americans to the ranks of the health-insured will chip away at that success story. The opposite seems more likely.

Well, actual empirical evidence that something is really truly real and true doesn’t make a dent with wingnuts, especially if Hannity/Beck/Limbaugh et al. are telling them it isn’t true, based on the fact that Beck can write something about it on a chalkboard. But the fact that the insurance industry is coming around on this and doesn’t want most of health care reform repealed is a strong indication that most of it will not be messed with.

Congressional Republicans are going to have to put on a good show for the home folks, of course, so it wouldn’t surprise me if the House does pass the “Repealing the Job Killing Health Care Law Act”, because they know it’s unlikely to be passed in the Senate and most certainly would be vetoed.

I think, after that, they’ll target two or three provisions in the bill, because they have to give their supporters some kind of trophy to put on the wall. So maybe it will be a squirrel head and not a tiger head, but something.

However, the one part of the bill that polls say most people don’t like, the individual mandate, is going to be fiercely protected by the insurance industry lobbyists. Which means that Senate Republicans will get on board with it. But right now most of the Right so fervently believes that the individual mandate is evil and unconstitutional and the work of the devil, that I can’t imagine they’re going to be satisfied with the squirrel head. It’s possible failure to rescind the individual mandate could bite the GOP in the ass in 2012.

Anyway — I titled this post “Health Care Reform for Freedom” because I want to make a different point.

The Republicans have dubbed their healthcare bill the “Repealing the Job-Killing Health Care Law Act.” The primary evidence for their assertion is based on a line in the CBO analysis of the bill that estimates that the labor supply might drop by one-half of 1 percent as a result of the passage of the ACA. The Republicans multiplied the total number of jobs in the country by half a percent and came up with a total of 650,000 jobs lost. But, as has been pointed out innumerable times, a drop in the labor supply is not the same thing as employers cutting jobs because costs are too high. According to the CBO, healthcare reform could result in a lower labor supply because workers may voluntarily leave their jobs, secure in the knowledge that they would still have access to healthcare.

In other words, it’s not jobs that would be reduced. And I think even House Republicans can’t possibly be stupid enough not to understand that. Well, OK, there’s Michele Bachmann. But most of them can’t possibly be that stupid. I assume they can tie their own shoes and eat with a fork, and such.

I have met people who say they are holding on to a job mostly for the health benefits; otherwise, they’d rather work freelance. So I suspect the CBO is right; that once people can trust they can still get affordable health insurance without holding on to a job, some people will give up jobs they otherwise don’t need and let someone else have them. Seems to me that would reduce unemployment, not add to it.

And then there are the people who cannot change jobs because they have pre-existing conditions. This is another point righties can’t seem to grasp. I give you, for example, Don Surber:

Now that Republicans plan to vote on repealing this unconstitutional law, Democrats are throwing up make-believe numbers to scare people.

From the Washington Post: “As many as 129 million Americans under age 65 have medical problems that are red flags for health insurers, according to an analysis that marks the government’s first attempt to quantify the number of people at risk of being rejected by insurance companies or paying more for coverage.”

So, 65% of the 200 million people with health insurance through their employer are so diseased no one will insure them.

This makes no sense.

The story does not define just what these red flags are.

But the 65% figure contradicts what Democrats previously said about the uninsured.

From the story: “The new report says that, of those Americans who are uninsured, 17 percent to 46 percent have medical conditions, depending on the definition used.”

Behold the lack of critical thinking skills. Surber assumes the “pre-existing conditions” issue only exists among the uninsured, but that’s not what the article he quoted says. That’s 65 percent of all Americans, not just those who don’t have insurance now.

And of course this is significant because there must be millions of people in the U.S. who do have insurance now but who would be uninsurable if they lost that insurance, which happens every day.

New York state already has a “guaranteed issue” provision, so that if you take a new job, or change jobs, your new employer’s health insurance provider can’t refuse to insure you because you have a pre-existing condition.

And you know what that gives people? More freedom. If you don’t like your job, if you get a better offer, you can leave your old job knowing that you will be able to get health benefits from your new employer.

I understand that people in other states often are stuck in jobs because they are afraid they will lose their insurance if they leave, even for higher salaries, because the lack of health insurance is too much of a financial risk for most people.

Don’s problem is that he doesn’t understand what insurance is:

Of course it makes sense that those with health conditions would be more likely to seek health insurance than those who are healthy — which is one of the arguments against Obamacare; not everyone needs health insurance.

This is the sort of idiocy that does inspire one to bang one’s head on the wall and scream for a while to make the pain go away.

This guy assumes you don’t need health insurance until you get sick. Does he think you don’t need auto insurance until you smack into a tree? That you don’t need homeowner’s insurance until after the tree crashes through your roof?

Does he not understand that if you wait until you have a health condition before you try to purchase insurance, in most states, the insurers won’t sell you a policy? For any amount of money?

Does he not understand that the insurance companies’ business model requires that lots of people get insurance policies who don’t need them (at the moment)? How does he think insurance works? You pay your premiums — a few hundred dollars a year — and then poof! Bills for medical care in the tens of thousands magically disappear!

Of course, the cost of medical care does not disappear. So when the healthy 26-year-old who didn’t bother to sign up for his employer’s health benefits gets hit by a truck and gets hauled into the emergency room and runs of tens, maybe hundreds, of thousands of dollars in medical bills he can’t pay, guess who pays for that health care? Everybody — the hospital pads everybody else’s bill to cover the money they lose from people who can’t pay. Contrary to wingnut mythology, emergency rooms ain’t “free.”

And if the accident leaves him with a condition that requires long-term care and rehabilitation therapy, good luck finding a medical facility that will provide that if the guy can’t pay. Emergency rooms are only required to stabilize people so that they don’t die; after that, most of the time, you’re on your own.

People without insurance who get medical care they can’t pay for are costing all of us. People with jobs who have access to health benefits and choose to not sign up are freeloaders.

And people wonder sometimes why I refuse to “reason” with wingnuts.

Anyway — I want to go back to the freedom thing. Once the health care reform act is fully in place, with the individual mandate and guaranteed issue provisions intact, millions of people will be set free — to change jobs, to leave jobs and strike out on their own, to finally get medical treatment for conditions that are holding them back. Lots of people will be given career and other choices they don’t have now.

Unless —

At New Republic, Jonathan Cohn writes that it’s still possible health care reform will be nullified by wingnut activist judges ruling from the bench. And one never knows what the courts will do, including the Supreme Court. However, I can’t imagine Justice John Roberts et al. ruling against something the insurance industry wants, and the insurance industry wants the individual mandate.

See also Cohn’s attempts to “reason” with a wingnut lawyer behind one of the constitutional challenges of reform:

A few weeks ago, I spoke with Hyder at his office, in order to learn more about why he had brought this case. He said his motive was straightforward. He’s opted not to carry health insurance because he doesn’t think the benefits justify the price, and he doesn’t want the government forcing him to do otherwise. Okay, I asked, but what if he gets sick and needs hospitalization? How will he afford those bills? It was a distinct possibility, he agreed, patting his waist and noting that he was a little overweight. But those potential bills would be problems for him and his hospital, he suggested, not society as a whole.

When I told him that I disagreed—that his decision to forgo health insurance meant other people would be paying his bills, via higher taxes and insurance premiums—he politely and respectfully took issue with my analysis. The discussion went back and forth for a while, but soon it became apparent that our differences went beyond the finer points of health care policy, to our most basic understanding of the rights and obligations of citizenship. “It’s a complete intrusion into my business and into my private life,” he told me. “I think it’s one big step towards a socialist society and I’m purely capitalist. I believe in supply-side economics and freedom.”

Freedom? whose freedom? He wants to be “free” of having to pay for health insurance. And who wouldn’t? It’s expensive. I wish I could be free of it, too. But to pay for this “freedom,” millions of other people have to be less free, because they are tied by their health insurance to jobs they might wish to leave.

The Cohn article goes on to explain the legal precedents for the constitutionality of the individual mandate, which is a pretty good read, too.

Introduction: I started to write an answer to a comment, then when it got a bit long I decided to turn it into a post. I am responding to a comment from Tim, which turns out to have been copied and pasted wholesale from Vox Populi. But here’s my response, addressing Tim:

Tim, there’s much here you don’t seem to understand. Let me see if I can explain it to you in plain English.

First, some background: Congressional Budget Office analysis of the badly named “Patient Protection and Affordable Care Act of 2010” (PPACA), probably known to you as “Obamacare,” said it would REDUCE the federal deficit by $143 billion over ten years. I am providing a link to the CBO analysis so you can read this for yourself: I don’t have time to write a Cliff’s Notes summary or you to show you where the savings come from, but I will give you the benefit of the doubt and assume that you are as capable of reading and understanding it as I am.

Just don’t try to argue with me about this until you have read the analysis. I will know.

Also note that “That’s stupid; everybody knows it’s going to raise the deficit” is not an argument. You have to provide reasons and data to show that the points made in the analysis are wrong. And I require links to show where you are getting your data. Otherwise, you don’t have an argument. On this blog, you don’t get away with pulling some data out of your ass and make me do the work of figuring out where you got it so I can refute it. (See “debating rules for rightwingers,” item #8.)

You write, “The CBO’s revised estimate for health care reform, which does NOT include the Medicare fix, is $1,055 billion.” Obviously, there is a discrepancy between what you say and what the actual report, to which I linked, actually says. I couldn’t find the figure “$1,055 billion” in the actual CBO report anywhere.

And the Medicare fix is not included in the CBO analysis because the Medicare fix is an entirely separate issue from the PPACA. The Medicare fix issue has been with us for several years and is the result of legislation passed back in 1997, and it will not go away if “Obamacare” is repealed. I’ll come back to this point later in this post.

Now, the House Republicans have written a stupidly named bill called the “Repealing the Job Killing Health Care Law Act” — notice the link; you can see for yurself the title is about as long as the bill.

The CBO figures that repealing health care reform would ADD $230 billion to the deficit over ten years and result in 32 million fewer people having health insurance by 2021. Such a deal. You can read that report for yourself also, if you like.

House Speaker John Beohner dismissed the CBO analysis as “their opinion.” But in order to get you tools budget-conscious conservatives to support repeal, Republicans had to concoct their own analysis to show the opposite of what the CBO analyses show.

So, somehow, Republicans calculated that the CBO got it backward, and that PPACA would add to the deficit and repealing it would reduce the deficit. Several people, not just Krugman, have written that Republicans do this in part by claiming costs for the PPACA that are not in the PPACA.

And frankly, I have to take their word on this, because I’ve been all over the web looking for a Republican analysis that spells out costs and savings in the same way the CBO analysis does, and I can’t find it. So I can’t say for sure how they crunched their numbers. If you know where it is, send me a link.

Please note that a list of unsupported claims is not the same thing as an analysis. As my math teachers used to say, you gotta show the work.

But note also that House Republicans have decided to exempt the repeal bill from their own rule that any increase in spending be offset by cuts in other programs. This suggests to me they know good and well they are lying.

What Krugman is saying here is that the Republican analysis is a crock that adds items as “cost” that don’t have anything to do with PPACA and which are going to happen whether PPACA is repealed or not. For example, he says, Republicans have added the cost of the annual Medicare “doc fix” to the cost of PPACA, which is an issue entirely outside of PPACA.

Then, you write, “Krugman is assuming that the Medicare fix is as inevitable as a mortgage payment. . . . the possibility that doctors might elect not to see Medicare patients hardly makes increasing Medicare payments a necessity.”

First, you should be aware that in dismissing the Medicare fix issue, you are arguing AGAINST the Republican analysis. Krugman is saying that REPUBLICANS claim the Medicare fix as an inevitable cost of the PPACA, and they’re putting that into the secret analysis I can’t find to argue that “Obamacare” is too expensive.

But here’s what you’re not getting — the bleeping Medicare reimbursement rate shortfall was NOT CAUSED BY THE PPACA AND WILL STILL BE DRAINING MONEY OUT OF THE BUDGET IF PPACA IS REPEALED. That was Krugman’s point.

Righties have insinuated elsewhere that by repealing PPACA they’d be saving the “doc fix” costs, but they won’t, because the ‘doc fix” issue was caused by legislation passed back in 1997 and will not be affected if PPACA is repealed. I’ve written about this, um, prevarication in the past. See:

“How the Game Is Played”
Die Quickly for the GOP’ or, Righties Still Can’t Read

By the same token, if Congress wants to stop issuing the annual Medicare doc “fix” and allow physician reimbursement rates to drop by 23 percent, or more, they wouldn’t have to repeal “Obamacare” to do that, because it’s bleeping not in “Obamacare.”

So, essentially, your entire argument not only misses Krugman’s point, it also misses the point of GOP propaganda arguments. Hmm, maybe I shouldn’t assume you are as capable of reading CBO analyses as I am.