So how do we know that Obamacare is a success? There’s all the standard measures: enrollment numbers, decreases in uninsured, stable or dropping medical costs, deficit savings, etc. – which are all looking great, by the way. And then there’s Kit Bond’s recent Op-Ed in the St. Louis Post-Dispatch.

An editorial note at the end of the post, notes that Bond’s lobbying firm has taken on the thankless task of promoting the Obamacare Medicare expansion – an expansion that the obdurate, anti-Obama, ideologically-blindered State Legislature just won’t countenance (if you listen carefully you just might hear the sound of tiny stamping feet and spluttering screams of “no, no, we won’t, you can’t make us” echoing off in the distance). The Op-Ed reveals Bond’s strategy for dealing with the ferocious anti-Obama-on-funny-but-misguided-principle crowd in and out of the legislature: pretend that Medicaid expansion has nothing to do with the loathsome program.

The first thing you will note about the Op-Ed is it’s evasiveness. It only mentions the Medicaid expansion once, near the end of the piece, and only equates it with the Obamacare legislation obliquely. Instead, Bond, cleverly cries a few tears over the problem of hospital closings in Missouri, problems he attributes mostly to “Obamacare-mandated cuts in funds hospitals receive for uncompensated care – the care hospitals are required by law to provide regardless of folks’ ability to pay.”

Since Bond knows his audience very well, he fails to point out that these hospital closings could far more honestly be attributed to the failure of the legislature to accept the Medicaid expansion funds offered through Obamacare, funds for care which was intended to take the place of the emergency room as the main mechanism for care of the uninsured and so offset the loss of federal emergency care dollars – and emergency room care is, incidentally, a far more costly and inefficient way of dealing with the uninsured than granting insurance through Medicaid. Aren’t Republicans supposed to be the financially responsible ones?

Instead Bond argues that the answer to the loss of these funds is to enable hospital mergers as a way to keep the hospitals pinched by the loss of emergency room funds functioning in underserved communities. And then he decries the fact that the Federal Trade Commisison (FTC) review process, which has the power to okay or deep-six a proposed merger, is, guess what, thorough. Or, the short version, the FTC does what it’s supposed to do and Bond knows that that gets his intended audience hot under the collar because, you know, big government:

Despite helping to create the problem for hospitals with expensive new mandates and cuts to reimbursements, the federal government is now making it difficult for these hospitals to deploy this private-sector solution. Currently, the Federal Trade Commission is moving painfully slow to evaluate any proposed merger or system expansion. Reviewing applications through the narrow lens of a century-old anti-trust law, the FTC is taking months or even years of bureaucratic analysis to approve these hospital partnerships – often too late for a community on the brink of losing its only hospital and largest employer.

Despite Bond’s anti-Obamacare, anti-FTC song-and-dance, Obamacare has actually been fueling hospital consolidation. But, Bond’s encomium to the merged entity that became  BJC HealthCare in the St. Louis area offers only one view of the possible outcomes of such mergers. Ill-considered consolidations have the potential to raise consumer prices, create physical access problems, as well as barriers to access to reproductive health services. As an article in Becker’s Hospital Review points out, there are a number of factors that determine whether a merger will be benign or harmful. Hence the FTC review process. It’s there to protects us, the consumers of health services – something Republicans don’t seem to understand or care about.

But of course, this whole, lengthy argument is not the real point of Bond’s Op-Ed, and is stealthily followed by this little tidbit:

Inaction by legislators in Jefferson City is also putting our health care safety net in Missouri at risk. State Sen. Ryan Silvey, R-Kansas City, has proposed a solution to reform our state’s Medicaid program that would increase access to care for hardworking Missourians, protect our health care safety net in rural and urban communities, and safeguard the state’s budget.

Unfortunately, anger over Obamacare has confused the issue, and right now, legislators are refusing to consider this common-sense solution … .

Senator Silvey’s proposal? Simply a way to try to make Obamacare Medicaid expansion somewhat palatable to the GOP heads-up-their-backsides contingent of the state lege. Such expansion, all by itself, could take care of the squeeze that the loss of federal emergency room dollars creates for hospitals. But – and here’s the magic of Bond’s rhetoric – in this article, it’s been aligned with “common-sense,” GOP-acceptable solutions to healthcare problems that Bond alleges to have been caused by that big winger bogey, big government, including – wait for it – Obamacare itself. One could read this article and leave persuaded that Silvey’s proposals have nothing to do with Obamacare and are only exciting opposition because the tentacles of evil Obamacare have confused the thinking of the poor souls in the Missouri capital.

Wow! Talk about tangled logic. Kit Bond, I salute you.

What this tells us is that conservatives who are capable of distinguishing their front from their backsides, know that Obamacare is a success and that now is the time to get Missouri in on it and let Missourians share that success. The deviousness of this piece of casuistry also reaffirms that reasonable conservatives also understand the real reason that Missourians don’t have this benefit – unbalanced, hysterical hatred of Barack Obama on the part of GOPers who can’t accept the failure of the dream of the conservative Reich that took root during the Bush years, and on the part of constituents who either fear and hate the black man in the white house, mostly because of that black-white dichotomy, or who credulously swallow all the nonsense their Foxified leaders have been spewing in their war against the godless, socialist Kenyan and his Nazi hordes.

And the funny thing? Politicians like Bond were more than willing to fan this hysterical fervor; they thought it was their ticket back into power. Now they have to serve it – or, as Bond is trying to do in his Op-Ed, trick the true believers and give GOPers in the lege a way to save face. Because Obamacare is a success and now we know they know it too – they just can’t say it out loud.

Silence can be much more revealing than what a person actually says.

Let’s consider Hartzler’s latest newsletter.

Of course, she want to repeals the ACA, but has not clear recommendations on what to replace it with:

As we begin the new year, I remain committed to working with my colleagues in Congress to end this disastrous law and to replace it with health care options that offer all Americans access to quality, affordable health coverage they want.

I want to consider two other examples.

She takes no bow for how much money will be saved from the budget by extending long term unemployment benefits.  We can all wonder why.

One of the reasons Hartzler cites to replace Obamacare is the following problem.

There’s a chance many people who thought they had enrolled in various health care plans are not actually enrolled, after all. Many Americans who signed up through the government exchanges have been incorrectly informed they enrolled in plans. If you’re in this category you might be in for a big shock early in the new year when you learn that while you were informed you had enrolled, the insurance company you thought you had signed up with might know nothing about you. Bottom line – you might not have coverage!

[I won’t note that these government exchanges are actually coverage by PRIVATE companies.}

This is serious: some of her constituents who thought they have insurance might not. However, she offers NO advice on how to find out whether one is enrolled or not.  Nice non-service for something that is important.

There is this “good” news:

I am pleased to share that even though Congress was not in session, negotiators from the House and Senate Agriculture Committees were at work hammering out the final details of what I hope will be a comprehensive five-year Farm Bill. There are still differences between the House and Senate versions of the Farm Bill, but the principle negotiators are making significant progress and the conferees plan to vote the first full week back in January. As a member of the House Agriculture Committee, I am committed to serving the interests of both consumers and farmers – approving a Farm Bill that provides the United States with a safe, plentiful, and affordable supply of food for many years to come.

We don’t need to note that a significant portion of the Farm Bill will be GOVERNMENT supported crop insurance.  

What is missing in this good news is any mention of providing Americans who are food insecure with help.  (Missouri has the highest percentage of people who are food insecure in the country.) There was a time when the Farm Bill had such support.

What Hartzler doesn’t say is much more important than what she says.