Remember back in 2011 when Rep. Ann Wagner was running to be the Republican National Committee chair? Specifically when she tried to outman the men on the candidate list when it came to gun love?:

Republican National Committee chair candidate Ann Wagner blew away the competition when Grover Norquist asked each candidate at today’s debate how many guns they own.

“About 16,” replied Wagner, whose family actually just got a new gun case for Christmas.

Current RNC Chairman Michael Steele and Mario Cino don’t own any guys. Reince Priebus has five, and Saul Anuzis said he feels “very inadequate” owning just four.

Back in those days you had to feel for poor Ann who, as one of the few women with a stomach strong enough for our modern GOP, had to cope with all that angry, old, white testosterone. Especially since, when push came to shove,  her 16 guns weren’t enough to prevail against Reince Pirebus’ teeensy, tiny five.

Recently, however, given the party’s need to attract women, and the few that the party has to hand, Wagner has seen her star ascending – to the extent that she has become one of the players involved in helping select a new GOP majority leader now that Eric Cantor has been tea-partied out of the Congress. Consequently, given Wagner’s status in the GOP’s effort at female outreach, our task over the next few weeks is to be alert for a possible change in her pronouncements on the topic of the Affordable Care Act (ACA or Obamacare).

Why, you may ask? Wagner, after all has been running in tandem with the repeal-the-ACA crowd, and, true to her faux woman of the people stance, has regularly solicited ACA horror stories that she can pass along without real verification, but with an “I told you so” smirk instead. Why, you ask, should she change? Simply because there’s a big problem with this strategy. Most of the horror stories have proven to be bogus and all the signs are that the Affordable Care Act is succeeding. Consequently, as Greg Sargent observes, the GOP is scrambling to develop a new rhetorical tack:

Reuters reports GOP officials have conducted reams of research to retool their message, with an emphasis on appealing to women. The problem: Balancing the base’s demand for an undying commitment to obliterating the law with swing voters’ desire to keep the good things in it. Solution: Use the phrase “start over” instead of “repeal,” because “start over” supposedly resonates with women.

It’ll be interesting to see if this new direction takes with the members of the Missouri delegation, but especially with Wagner – precisely because she’s not only a woman, but a woman of the sort that the GOP establishment hopes can speak effectively to female swing voters. It’s going to be fun watching to see how emphatically Wagner adopts this line if at all. If she does, these are, according to Sargent, the points to watch for:

The new “start over” message will not paper over the basic problem Republicans face here, which is that they want the base to thrill at their anti-Obamacare zeal while also reassuring swing voters they can have the good stuff in the law without the bad. Indeed, as you watch this “new” message, keep an eye on whether GOP candidates actually do call for “starting over” in any meaningful or substantive sense. Instead, you’ll likely hear them claim they want to “start over” while mouthing support for the law’s goals of expanding affordable coverage and consumer protections, while refusing to take a stand on whether key aspects of it – such as the Medicaid expansion – should actually be done away with.

If Wagner and the other Missouri GOPers do decide that “start over” is the way to go, we need to make sure that they have a good story about how they are going to replace the benefits that the ACA has given to Missourians. A recent Department of Health and Human Services report tells us that the average insurance premium for Missourians getting insurance through the ACA exchanges is only $59. Without ACA subsidies, premiums for similar private market insurance would have cost on average $344; the ACA subsidized insurance is 85% cheaper.

If Wagner, specifically, starts talking about “starting over” we need to hold her feet to the fire and demand to know how what she has in mind would work better than the ACA. There are better systems out there, but I’m willing to bet that hardcore Republicans would never sign on to them. Instead, As Sargent noted in an earlier article about the effort of Republicans to maneuvre around the incipient success of Obamacare:

… surely these Republican evasions are also newsworthy. They go right to the heart of the GOP’s approach to the central policy debate of the Obama era, shedding light on Republicans’ widespread inability to mount an even remotely credible policy response to fundamental questions that debate raises about how, or whether, government should act to expand health care to the poor. And they cast doubt on the veracity of the Obamacare-is-a-disaster political narrative that is central to the highly consequential midterm elections now underway. All this should be part of the story.

The most recent email newsletter that I got from my Congresswoman, Rep. Ann Wagner (R-2), Ann’s Weekly Roundup, focused on the scandal attendant on the long waits that many veterans have to endure in order to get care at VA hospitals. Wagner, needless to say, wants us to know she’s utterly, utterly aghast – even though she had little or nothing to say in February when her GOP compatriots in the Senate blocked Bernie Sander’s bill, S. 1982, that would have not only expanded the range of care available to veterans, but would have helped to alleviate the situation at notably overtaxed VA hospitals by providing for 27 new medical faciliities, facilities that, in the wake of the Iraq and Afghanistan wars are desperately needed.

Instead of addressing the real issue and acknowledging its genesis, Wagner prefers to troll veterans looking for more horror stories to back up her spurious claim that “the American people cannot trust the VA to correctly identify and address all deficiencies plaguing this agency.”  In fact, as Danny Vinik cogently argues in TNR, it’s more likely that only the VA itself can address the real problems – provided the funds to do so are made available.

Of course Wagner, in line with the notably dishonest GOP thrust toward privatization, doesn’t want us to believe we can trust the VA so she notably fails to mention the great job it does once folks get past door, or  the fact that “the VA healthcare system has consistently out-performed the non-VA/private sector in quality of care and patient safety.” Not a word from Wagner that the waiting period to see a doctor is, in many cases as long in the private sector as it is at most VA hospitals.

No, Wagner wants to send veterans into the private sector. For Wagner, who shows every sign of wanting to climb the GOP’s leadership ladder, the important thing is that there’s a problem at the VA that can be exploited by the pro-privatization fanatics in the GOP. Consequently, Wagner’s touting her role as a co-sponsor of the Veterans Access to Care Act, “which would allow any Veteran forced to wait more than thirty days for an appointment, the option to receive private-sector care.” Like most in the GOP, she ignores the spectular failures of the private sector in delivering health care in our free enterprise Wild, Wild West. Nor does Wagner, again in common with the rest of her GOP cohorts,  seem to be aware that this solution lacks the support of many veteran service organizations that ” long have feared such moves as a step toward dismantling their prized, fully integrated VA health system.”

But there’s still another dimension to the VA scandal that is truly scandalous serious.  It seems that staff in the Phoenix VA falsified patient wait-time records. It’s likely they did so because the VA was not only under pressure to cut wait times to 14 days, an interval that, given the myriad pressures on the system, was totally unrealistic, but because financial incentives were offered for achieving this wait time. This serious lapse has, of course, gotten everyone justifiably worked up; but only Republicans have tried to exploit it to favor their anti-government ideology:

“(The) VA’s sordid bonus culture is a symptom of a much bigger organizational problem: The department’s extreme reluctance to hold employees and executives accountable for mismanagement that harms veterans,” said House Veterans’ Affairs Committee Chairman Jeff Miller, R-Fla.

Which leads me to point out that the use of financial incentives is not unique to the public sector, It is a motivational mechanism that the VA along with other nonprofits has borrowed from that GOP icon, the private sector, where it has an equally spotty record. Take for instance, the issue of bonuses paid out to business executives. The Economist reports on a study that concludes that, “of the largest companies in America (those in the S&P 100), CEO pay has no correlation with either performance or market capitalisation.” Does this bother those GOPers like Wagner who champion the supposedly greater efficiencies of the marketplace? It certainly didn’t in 2009 when the GOP came out swinging to protect the bonuses “owed” to the CEOs of bailed out banks.

The issue in both the public and private sector is not the use of incentives per se, but the degree to which they are tied to realistic, easily verifiable goals. Cheating at the VA is akin to that in the education field where we find schools where merit pay as well as the survival of the school itself depends on students’ test scores while, at the same time, the school district is without the wherewithal to enable it to address the complex issues that lead to low test performance. Since the stakes are high and there’s no way to succeed, sometimes they cheat. Same at the VA.  

It’s not surprising that people who have to meet unrealistic goals to avoid censure as well as to supplement their income will cheat when they think they can get away with it. It’s a sad fact, but it happens. It happens in the private and the public sector and the conditions that give rise to such cheating need to be addressed. And in the case of the VA, putting veterans into the private health care system does nothing to address the issues – although it will up the costs for the American taxpayer. According to Danny Vinik:

… the Congressional Budget Office reported that allowing certain veterans to seek care at non-VA facilities would cost $35 billion over the two-year program, as The New Republic’s Brian Beutler predicted. If made permanent, CBO estimates it could cost $50 billion a year. For comparison, the VA currently spends $44 billion a year on its health care system. CBO notes that its estimate is preliminary, but it still is much higher than the expected cost. And this is only for the partial privatization part of the bill.

While the potential for a new $50 billion a year program is worrisome, the bill would not even address the underlying problems at the VA.

It’s not surprising that Rep. Wagner is touting a bill that opens the VA door slightly to privatization, but it is tragic that so many Democrats have allowed themselves to be stampeded through that door by the media circus that folks like Wagner have ramped up. Do we really want to pay more to give our soldiers so-so care? Or do we want to fix the real problems at the VA where doctors specialize in the specific issues that affect those in the military? Two Republicans voted against the bill because of its cost – and for once they were right to do so, given the dubious nature of its main provision. Why, though, were there no Democrats willing to stand against what Vinik identifies as a privatization “trojan horse.”